How much does antibody investigation cost in chronically-transfused patients with myelodysplastic syndromes (mds)?

Abstract

Background: Many patients with MDS are chronically transfused, but the cost of transfusion is poorly understood beyond the manufacturing cost of the product. Antibody (Ab) investigations require additional time and may require ordering of phenotype-matched blood, which adds cost and can slow red blood cell (RBC) provision. We conducted a prospective time-driven activity-based costing study of patients with MDS receiving RBC transfusion at an Australian tertiary hospital to examine the health service costs of RBC transfusion. Aim(s): To compare the cost of providing RBCs for MDS outpatients with and without RBC Abs. Method(s): Every process in the health service provision of a single RBC transfusion was mapped and timed. Costs of equipment, consumables, staff time and overheads in each process were calculated to reach a weighted cost and weighted time, taking into account the probability of decision-points within each process. Total costs and times were compared for patients with and without RBC Abs. Six months of representative data for MDS patients were collected from May-Oct 2022 to determine resource use. Result(s): Steps in the process for a patient receiving a single unit RBC transfusion in the outpatient setting are shown in Table 1. Of 41 patients who had 248 group and screens (G&S), 17% had known Abs. A total of 260 RBCs were transfused to 28 patients (median 2 RBCs [range 1-40]; median 1 transfusion episode [range 1-23 episodes]). There were 142 computer-assigned episodes and 14 episodes by automated serologic/IAT crossmatch. Patient phenotyping was performed once. RBC unit phenotyping was performed 14 times. Five transfusion reaction investigations were performed in 2 patients. The cost and time for outpatient pathology, specimen reception, blood transport and transfusion were identical for patients with and without Abs. Excluding the cost of the RBC and including fixed hospital costs of $46.16, the total weighted cost [weighted time] of transfusion for a known patient without Abs was $163.66 [172 mins], compared to $214.11 [262 mins] for a patient with simple Abs; with a cost difference of $50.45 and an additional 90 min of staff time. The weighted cost [weighted time] of a more complex Ab investigation with an elution was an additional $127.40 [46 min], with referral to the reference laboratory an additional $7.52 [26 min], and a transfusion reaction investigation was an additional $92.26 [236 min], totalling an additional $227.18 [308 min]. Summary/Conclusions: Measures to avoid alloimmunisation and to securely share data on known antibodies (such as a national antibody register) may benefit both patients and health services, reducing adverse events, staff time and costs.