title: Outpatient red blood cell transfusion payments among patients on chronic dialysis.
abstract: BACKGROUND
  Payments for red blood cell (RBC) transfusions are separate from US Medicare bundled payments for dialysis-related services and medications. Our objective was to examine the economic burden for payers when chronic dialysis patients receive outpatient RBC transfusions.
  
  
  METHODS
  Using Truven Health MarketScan® data (1/1/02-10/31/10) in this retrospective micro-costing economic analysis, we analyzed data from chronic dialysis patients who underwent at least 1 outpatient RBC transfusion who had at least 6 months of continuous enrollment prior to initial dialysis claim and at least 30 days post-transfusion follow-up. A conceptual model of transfusion-associated resource use based on current literature was employed to estimate outpatient RBC transfusion payments. Total payments per RBC transfusion episode included screening/monitoring (within 3 days), blood acquisition/administration (within 2 days), and associated complications (within 3 days for acute events; up to 45 days for chronic events).
  
  
  RESULTS
  A total of 3283 patient transfusion episodes were included; 56.4% were men and 40.9% had Medicare supplemental insurance. Mean (standard deviation [SD]) age was 60.9 (15.0) years, and mean Charlson comorbidity index was 4.3 (2.5). During a mean (SD) follow-up of 495 (474) days, patients had a mean of 2.2 (3.8) outpatient RBC transfusion episodes. Mean/median (SD) total payment per RBC transfusion episode was $854/$427 ($2,060) with 72.1% attributable to blood acquisition and administration payments. Complication payments ranged from mean (SD) $213 ($168) for delayed hemolytic transfusion reaction to $19,466 ($15,424) for congestive heart failure.
  
  
  CONCLUSIONS
  Payments for outpatient RBC transfusion episodes were driven by blood acquisition and administration payments. While infrequent, transfusion complications increased payments substantially when they occurred.
authors.affiliation: Amgen, Inc,, One Amgen Center Drive, Thousand Oaks, CA, USA. mgitlin@amgen.com
authors.forename: Matthew
authors.initials: M
authors.lastname: Gitlin
authors.forename: J Andrew
authors.initials: JA
authors.lastname: Lee
authors.forename: David M
authors.initials: DM
authors.lastname: Spiegel
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Carson
authors.forename: Xue
authors.initials: X
authors.lastname: Song
authors.forename: Brian S
authors.initials: BS
authors.lastname: Custer
authors.forename: Zhun
authors.initials: Z
authors.lastname: Cao
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Cappell
authors.forename: Helen V
authors.initials: HV
authors.lastname: Varker
authors.forename: Shaowei
authors.initials: S
authors.lastname: Wan
authors.forename: Akhtar
authors.initials: A
authors.lastname: Ashfaq
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics* / Q000639:trends; D017707:Erythrocyte Transfusion / Q000191:economics* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D005102:Health Expenditures / Q000639:trends; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics / Q000639:trends; D008875:Middle Aged; D006435:Renal Dialysis / Q000191:economics* / Q000639:trends; D051436:Renal Insufficiency, Chronic / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology