Cost of transfusion-dependent myelodysplastic syndrome (MDS) from a German payer’s perspective

Abstract

Background: No curative treatment exists for patients with myelodysplastic syndrome (MDS) besides allogeneic stem cell transplantation. Hence, palliative treatment is provided for a life time accruing high health care cost. As no cost study of MDS exists in Germany, the objective of this study was to assess and analyse costs of transfusion-dependent low/intermediate-1 risk MDS in Germany from a payers' perspective. Patients and methods: 116 low/intermediate-1 risk transfusion-dependent MDS patients with and without isolated 5q-deletion from seven centers were identified. Claims data and patient records of the previous five years were used to collect health care utilization data retrospectively. Publicly available tariff books and remuneration schemes were applied to evaluate mean costs per year in Euro with 2007 as base year. Results: The annual cost of MDS patients was estimated at €14,883. Subgroup analyses showed differences in patient's characteristics and outcomes among patients treated at a hospital based versus an office based setting. Patients treated at the hospital based registry show higher cost where as the reasons for that still need to be detected. Overall per annum direct costs range from €12,543 (SD 12,967) to €24,957 (SD 36,399) in different subgroups of patients. In both groups, patients with 5q-deletion use more medication than those without deletion. Mean costs for medication in the office based setting are €5,902 for patients with isolated 5q-deletion vs. €3,932 with no deletion, respectively. Conclusion: MDS leads to a high health care utilization and resulting costs for the health care system which requires a detailed analysis of underlying services.Response to Reviewers: For reasons of a better outline, we decided to respond to your comments in a word document which is attached. Response to reviewer's comments Reviewer's comments ResponsesReviewer #1:In this retrospective study, the authors have evaluated the annual cost of MDS transfused patients in Germany. They stated that patients with 5q-deletion used significantly more resources and especially more medication than those without deletion. This paper raise two majors Criticisms : -1st. The way the data were retrospectively collected raise some issues.In fact the authors compared MDS and del5q but the collection of data were rather different in the two groups and this might also (in part) explain the difference observed in the two groups.Thank you for raising this point. We are aware of this limitation and tried to point it out in the discussion. As this was addressed as a major point by the first reviewer we decided that the respective section needed a revision, which we did in the results and discussion section.To further address this point that was also raised by the editor we conducted additional analyses of the data and present results for the center 7 (MDS registry at a university) separately in a new table 3. By this the differences in data collection and composition of the respective cohorts can be reflected. The fi...

Red blood cell transfusion burden in myelodysplastic syndromes (MDS) with ring Sideroblasts (RS): A retrospective multicenter study by the Groupe Francophone des Myélodysplasies (GFM)

“…26 Several studies have assessed the economic impact of repeated transfusions. 19,20,[27][28][29] Considering the costs of day care facility for RBC transfusions, transportation to and from hospital, pre-transfusion laboratory tests and iron chelation, but excluding the costs of inpatient hospitalization for complications, emergency room or general practitioner visits, we found a median transfusion cost of 16,188€/patient over 6 months. Frytak et al 20 estimated a mean annual costs of $51,066 for TD MDS patients, which was higher than in our study but included unplanned hospitalization costs.…”

Cost of chronic red blood cell transfusion in the Brazilian private healthcare sector from a payer perspective

“…In this scenario, the present approach combining CBHPM parameters and a reimbursement survey may be a useful strategy to estimate and update transfusion cost in the Brazilian private health care sector. Knowledge regarding transfusion cost is meaningful in a variety of contexts, from disorders requiring chronic transfusion, such as thalassemia (Burns et al, 2019) and MDS (Kuhne et al, 2010), to acute blood loss (Garcia-Roa et al, 2017). In the United Kingdom, a study focusing on lower vs. liberal levels of RBC administration to treat perioperative anemia associated with cardiac surgery (Stokes et al, 2016) has argued that the cost difference between the groups was "largely associated with the higher cost of red blood cells in the liberal group."…”

Drug‐Induced Blood Consumption: The Impact of Adverse Drug Reactions on Demand for Blood Components in German Departments of Internal Medicine

“…storage, blood typing, antibody screening test, cross‐matching, transfusion reactions, follow‐up tracking, blood count and coagulation profile) will arise that may be 3–5 times higher than blood procurement costs . These costs are not considered in our analysis even though they would significantly increase total costs . Furthermore, blood transfusion is associated with minor to severe adverse events such as allergic or febrile transfusion reactions, transfusion‐related acute lung injury, immunomodulation and transfusion‐transmitted or post‐operative infections.…”