The true cost of red cell transfusion for patients with myelodysplastic syndromes: A time-driven activity-based...

Patients with myelodysplastic syndromes (MDS) often require red blood cell (RBC) transfusion. However, the true cost of RBC transfusion, beyond the acquisition cost of the unit, is poorly defined. We conducted a prospective time-driven activity-based costing study at a large Australian university teaching hospital. Every activity relating to RBC transfusion in patients with MDS was observed and process-mapped, ranging from patient pre-transfusion phlebotomy through to laboratory processes, clinical transfusion in inpatient and outpatient wards, clinical follow-up and transfusion governance and oversight. For each activity, detailed data collection was undertaken, including timing of individual steps and recording all consumables, equipment and personnel involved. The total per-unit cost was US$440.47, with an annual per-patient estimated cost of US$6607.12. Hospital-related costs contributed 41% of the total cost, with the largest contributor being equipment (16%) followed by staffing (14%). Alloimmunisation increased process costs by 24%. These findings demonstrate that hospital process costs need to be included when considering and budgeting for the total cost of the transfusion process. Our findings will inform future transfusion-related resourcing and cost-effectiveness evaluations of treatments which aim to reduce RBC transfusion burden and improve quality of life in MDS.