Seema Kacker1, Paul M Ness, William J Savage, Kevin D Frick, R Sue Shirey, Karen E King, Aaron A R Tobian. 1. Department of Pathology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.
Abstract
BACKGROUND: Sickle cell disease is associated with extensive health care utilization; estimated lifetime costs exceed $460,000 per patient. Approximately 30% of chronically transfused sickle cell patients become alloimmunized to red blood cell antigens, but these patients cannot be identified a priori. Prospective antigen matching can prevent alloimmunization, but is costly and may not benefit most patients. STUDY DESIGN AND METHODS: A Markov-based model was constructed to compare the health and financial implications of four alternative antigen-matching strategies for chronically transfused sickle cell patients. The strategies varied by the group of patients receiving matched blood (all patients prophylactically or only patients with a history of alloimmunization [history-based]), and by the extent of antigen matching (limited to C, E, and K, or extended to 11 antigens). Direct medical costs and alloimmunization events were assessed over 10- and 20-year periods, for a hypothetical cohort of initially transfusion-naive patients and for a dynamic population. RESULTS: Within a hypothetical cohort of initially transfusion-naive patients, implementing prophylactic limited matching for all chronically transfused patients instead of history-based limited matching is expected to cost an additional $765.56 million over 10 years, but result in 2072 fewer alloimmunization events. Within the same cohort, implementing prospective extensive matching is expected to cost $1.86 billion more than history-based extensive matching, but result in 2424 fewer alloimmunization events. Averting a single alloimmunization event using prospective matching would cost $369,482 to $769,284. Among a dynamic population over 10 years, prospective limited matching is expected to cost $358.34 million more than history-based limited matching. CONCLUSIONS: While prospective matching for all transfused patients would reduce alloimmunization, this strategy requires considerable expenditure.
BACKGROUND:Sickle cell disease is associated with extensive health care utilization; estimated lifetime costs exceed $460,000 per patient. Approximately 30% of chronically transfused sickle cell patients become alloimmunized to red blood cell antigens, but these patients cannot be identified a priori. Prospective antigen matching can prevent alloimmunization, but is costly and may not benefit most patients. STUDY DESIGN AND METHODS: A Markov-based model was constructed to compare the health and financial implications of four alternative antigen-matching strategies for chronically transfused sickle cell patients. The strategies varied by the group of patients receiving matched blood (all patients prophylactically or only patients with a history of alloimmunization [history-based]), and by the extent of antigen matching (limited to C, E, and K, or extended to 11 antigens). Direct medical costs and alloimmunization events were assessed over 10- and 20-year periods, for a hypothetical cohort of initially transfusion-naive patients and for a dynamic population. RESULTS: Within a hypothetical cohort of initially transfusion-naive patients, implementing prophylactic limited matching for all chronically transfused patients instead of history-based limited matching is expected to cost an additional $765.56 million over 10 years, but result in 2072 fewer alloimmunization events. Within the same cohort, implementing prospective extensive matching is expected to cost $1.86 billion more than history-based extensive matching, but result in 2424 fewer alloimmunization events. Averting a single alloimmunization event using prospective matching would cost $369,482 to $769,284. Among a dynamic population over 10 years, prospective limited matching is expected to cost $358.34 million more than history-based limited matching. CONCLUSIONS: While prospective matching for all transfused patients would reduce alloimmunization, this strategy requires considerable expenditure.
Authors: Scott T Miller; Hae-Young Kim; Debra L Weiner; Carrie G Wager; Dianne Gallagher; Lori A Styles; Carlton D Dampier; Susan D Roseff Journal: Transfusion Date: 2012-07-13 Impact factor: 3.157
Authors: Seema Kacker; Paul M Ness; R Sue Shirey; William J Savage; Karen E King; Aaron A R Tobian Journal: Transfusion Date: 2015-01 Impact factor: 3.157
Authors: Willy A Flegel; Lilian Castilho; Wm Andrew L Heaton; Margaret A Keller; Ellen B Klapper; William J Lane; France Pirenne; Nadine Shehata; Gary Stack; Maryse St-Louis; Christopher A Tormey; Franz F Wagner; Dan A Waxman; Gregory A Denomme Journal: Blood Transfus Date: 2016-07-29 Impact factor: 3.443
Authors: Willy A Flegel; Qing Chen; Lilian Castilho; Margaret A Keller; Ellen B Klapper; William J Lane; France Pirenne; Gary Stack; Maryse St-Louis; Christopher A Tormey; Dan A Waxman; Christof Weinstock; Silvano Wendel; Gregory A Denomme Journal: Blood Transfus Date: 2018-02-14 Impact factor: 3.443
Authors: Matthew S Karafin; Matt Westlake; Ronald G Hauser; Christopher A Tormey; Philip J Norris; Nareg H Roubinian; Yanyun Wu; Darrell J Triulzi; Steve Kleinman; Jeanne E Hendrickson Journal: Br J Haematol Date: 2018-04-19 Impact factor: 6.998
Authors: Seema Kacker; Paul M Ness; William J Savage; Kevin D Frick; R Sue Shirey; Karen E King; Aaron A R Tobian Journal: Transfusion Date: 2014-02-27 Impact factor: 3.157