Cost-effectiveness of transfusion of platelet components prepared with pathogen inactivation treatment in the United States.
BACKGROUND
The Intercept Blood System (IBS) for platelets has been developed to reduce pathogen transmission risks during transfusions.


OBJECTIVE
This study was a comprehensive economic analysis of the cost-effectiveness of using the IBS for single-donor apheresis platelets (AP) and random-donor pooled platelet concentrates (PC) versus AP and PC without the IBS in the United States in patient populations in which platelets are commonly transfused.


METHODS
All data used in this analysis were summarized from existing published sources (primarily indexed in MEDLINE) and data on file at Baxter Healthcare Corporation (Chicago, Illinois) and Cerus Corporation (Concord, California). A literature-based decision-analytic model was developed to assess the economic costs and clinical outcomes associated with the use of AP and PC treated with the IBS for several conditions and procedures that account for a considerable proportion of the platelet usage in the United States: acute lymphocytic leukemia, non-Hodgkin's lymphoma, coronary artery bypass graft, and hip arthroplasty Risks of infection with HIV, hepatitis C virus (HCV), hepatitis B virus, human T-cell lymphotropic virus type 1, or bacterial agents were incorporated into the model. Possible benefits of reduction of the risk of emerging HCV like pathogens and elimination of the need for gamma irradiation were explored in sensitivity analyses.


RESULTS
The incremental cost per quality-adjusted life-year gained by using AP + IBS versus untreated AP ranged from 1,308,833 dollars to 4,451,650 dollars (without bacterial testing) and 4,759,401 dollars to 22,968,066 dollars (with bacterial testing). Corresponding figures for PC + IBS versus untreated PC ranged from 457,586 dollars to 1,816,060 dollars. Inclusion of emerging HCV like virus and the elimination of the need for gamma irradiation improved the cost-effectiveness to a range of 177,695 dollars to 1,058,127 dollars for AP without bacterial testing, 176,572 dollars to 1,330,703 dollars for AP with bacterial testing, and 22,888 dollars to 153,564 dollars for PC. The model was most likely to be affected by mortality from bacterial contamination, IBS effect on platelet utilization, and the inclusion of potential benefits (ie, gamma irradiation and/or emergent HCV-like virus). The model was relatively insensitive to changes in the IBS price and viral transmission risks.


CONCLUSIONS
The cost-effectiveness of pathogen inactivation via the IBS for platelets is comparable to that of other accepted blood safety interventions (eg, nucleic acid amplification technology). The IBS for platelets may be considered a desirable strategy to increase the safety of platelet transfusions and a potential insurance against the threat of emerging pathogens.
Bell
Christopher E
CE
Abt Associates Inc., Health Economic Research and Quality of Life Evaluation Services, Bethesda, Maryland, USA.
Botteman
Marc F
MF
Gao
Xin
X
Weissfeld
Joel L
JL
Postma
Maarten J
MJ
Pashos
Chris L
CL
Triulzi
Darrell
D
Staginnus
Ulf
U
D001424:Bacterial Infections / Q000517:prevention & control / Q000635:transmission; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D016239:MEDLINE; D017713:Platelet Transfusion / Q000009:adverse effects* / Q000191:economics* / Q000401:mortality; D018570:Risk Assessment; D012449:Safety; D012680:Sensitivity and Specificity; D013242:Sterilization / Q000191:economics* / Q000592:standards; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014777:Virus Diseases / Q000517:prevention & control / Q000635:transmission