Lara Antonieta Medina, Kandulu James, Chisuwo Laphiod, Kashoti Andrew, Mundy Catherine, Bates Imelda
Liverpool School of Tropical Medicine, Liverpool, UK.
J Clin Pathol. 2007 Oct;60(10):1117-20. doi: 10.1136/jcp.2006.042309. Epub 2007 Apr 5.
Despite policies advocating centralised transfusion services based on voluntary donors, the hospital-based replacement donor system is widespread in sub-Saharan Africa.
To evaluate the cost of all laboratory resources needed to provide a unit of safe blood in rural Malawi using the family replacement donor system
Full economic costs of all laboratory tests used to screen potential donors and to perform cross-matching were documented in a prospective, observational study in Ntcheu district hospital laboratory.
1729 potential donors were screened and 11,008 tests were performed to ensure that 1104 units of safe blood were available for transfusion. The annual cost of all transfusion-related tests (in 2005 USdollars) was USdollars 17,976, equivalent to USdollars 16.28 per unit of transfusion-ready blood. Transfusion-related tests used 53% of the laboratory's total annual expenditure of USdollars 33,608.
This is the first study to provide prospective economic costs of all laboratory tests associated with the family replacement donor system in a district hospital in Africa. Results show that despite potential economies of scale, a unit of blood from the centralised system costs about three times as much as one from the hospital-based "replacement" system. Factors affecting these relative costs are complex but are in part due to the cost of donor recruitment in centralised systems. In the replacement system the cost of donor recruitment is entirely borne by families of patients needing a blood transfusion.
尽管有政策倡导基于自愿献血者的集中输血服务，但撒哈拉以南非洲地区以医院为基础的替代献血者系统仍很普遍。
评估在马拉维农村地区使用家庭替代献血者系统提供一个单位安全血液所需的所有实验室资源成本。
在恩彻乌区医院实验室进行的一项前瞻性观察研究中，记录了用于筛查潜在献血者和进行交叉配血的所有实验室检测的全部经济成本。
共筛查了1729名潜在献血者，进行了11008次检测，以确保有1104个单位的安全血液可供输血。所有输血相关检测的年度成本（以2005年美元计）为17976美元，相当于每单位可供输血的血液成本为16.28美元。输血相关检测占实验室年度总支出33608美元的53%。
这是第一项提供非洲地区医院中与家庭替代献血者系统相关的所有实验室检测前瞻性经济成本的研究。结果表明，尽管可能存在规模经济，但集中系统提供的一个单位血液的成本约为基于医院的“替代”系统的三倍。影响这些相对成本的因素很复杂，但部分原因是集中系统中招募献血者的成本。在替代系统中，招募献血者的成本完全由需要输血的患者家属承担。
