Model Calculations to Quantify Clinical and Economic Effects of Pathogen Inactivation in Platelet Concentrates

Abstract

Background: Future shortages in platelet supply are expected in Germany due to demographic changes. A rising cancer incidence will lead to an increasing demand for platelet concentrates (PCs) while the number of potential donors will decrease. Pathogen inactivation (PI) aims to inactivate various infectious agents including emerging pathogens to extend the shelf-life of PCs and reduce the frequency of acute transfusion reactions (ATRs). In this context, the clinical and economic impact of PI on platelet transfusion was evaluated. Material and Methods: Model calculations were conducted for 2 scenarios considering different production settings. Frequencies of ATRs were based on literature analyses, platelet and ATR costs on cost analyses. Results: The estimated average costs for ATRs of grade 1 and 2, irrespective of origin, and grade 3 (allergic) were € 104, € 238, and € 1,200, respectively. Approximately 400 PC-related ATRs per 10⁵ transfusions can be avoided, with estimated savings amounting to € 77,000. The total cost increase was calculated to approximately € 30-50 per PI-treated PC. Conclusion: PI potentially saves plasma, prolongs shelf-life, decreases donor deferral, and reduces ATRs. Model calculations considering clinical and safety benefits of PI show a rational cost increase. The impact of PI should be further evaluated from a societal perspective regarding future blood supply and infectious disease globalization.

Clinical effectiveness of platelets in additive solution treated with two commercial pathogen‐reduction technologies

“…Further independent studies will be useful to corroborate this finding. Moreover, careful analyses of selected recipient types in different settings should be done using several methodological approaches to economic evaluations related to the implementation of PR platelets that have been reported in the literature . In parallel, strategies could be developed to investigate public acceptability of PR technologies …”

A systematic literature review on the use of platelet transfusions in patients with thrombocytopenia

“…Evidence is lacking for the cost-effectiveness of PT, and most studies examining the economic burden of PT in this SLR did not distinguish between prophylactic and therapeutic use. Available data show that PT represents a substantial cost burden [102], and this includes the higher costs associated with the management of transfusion-related AEs [135,136] and particularly those associated with PT-refractory status [102]. Measures to decrease PT-related costs could include implementing uniform management algorithms, as well as updating guidelines and protocols to include appropriately licensed treatment alternatives such as pharmacotherapy options.…”

“…Hospitalization due to transfusion-related sepsis cost $6408, whilst treating hepatitis B or C virus transfusion-related events cost between $1228 and $17,412 a year. In a further publication the estimated average treatment cost for acute-transfusion reactions (ATRs) in Germany was reported [136]. Grade 1 ATRs such as chills, fever and urticaria cost on average €104.…”

The long and winding road to pathogen reduction of platelets, red blood cells and whole blood

“…Readers interested in specific models and outcomes of cost analysis and their utilization to determine budget impact and cost-effectiveness of platelet PRTs and pathogen detection procedures are referred to reports from different jurisdictions and geographical regions (Staginnus & Corash, 2004;Berger et al, 2013;Girona-Llobera et al, 2014;McCullough et al, 2015;Agapova et al, 2015;Li et al, 2017;Cicchetti et al, 2018;Prioli et al, 2018;Ohlsson et al, 2018;Kacker et al, 2019). Local cost-effectiveness evaluations are greatly impacted by the local risk levels, which greatly vary in different geographical regions and during time.…”