Graduate School of Health Economics and Management (ALTEMS) - Università Cattolica del Sacro Cuore, Rome, Italy.
Blood Transfusion Service, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Blood Transfus. 2018 Nov;16(6):483-489. doi: 10.2450/2018.0115-18. Epub 2018 Sep 3.
Despite improvements in blood donor selection and screening procedures, transfusion recipients can still develop complications related to infections by known and emerging pathogens. Pathogen reduction technologies (PRT) have been developed to reduce such risks. The present study, developed whithin a wider health technology assessment (HTA) process, was undertaken to estimate the costs of the continuing increase in the use of platelet PRT in Italy.
A multidisciplinary team was established to perform the HTA and conduct a budget impact analysis. Quantitative data on platelet use were derived from the 2015 national blood transfusion report and from the Italian Platelets Transfusion Assessment Study (IPTAS). The current national fee of 60 Euro per platelet PRT procedure was used to quantify the costs to the Italian National Health Service (INHS). The analysis adopts a 3-year time-frame. In order to identify the impact on budget we compared a scenario representing an increased use of PRT platelets over time with a control scenario in which standard platelets are used.
Progressive implementation of PRT for 20%, 40% and 66% of annual adult platelet doses could generate an increase in annual costs for the INHS amounting to approximately 7, 14 and 23 million Euros, respectively. Use of kits and devices suitable for the treatment of multiple adult platelet doses in one PRT procedure could lower costs.
In order to fully evaluate the societal perspective of implementing platelet PRT, the increase in costs must be balanced against the expected benefits (prevention of transfusion-transmissible infections, white cell inactivation, extension of platelet storage, discontinuation of pathogen detection testing). Further studies based on actual numbers of platelet transfusion complications and their societal cost at a local level are needed to see the full cost to benefit ratio of platelet PRT implementation in Italy, and to promote equal treatment for all citizens.
尽管在献血者选择和筛选程序方面有所改进，但输血受者仍可能因已知和新出现的病原体而发生感染相关并发症。病原体减少技术（PRT）已被开发用于降低此类风险。本研究是在更广泛的卫生技术评估（HTA）过程中进行的，旨在估计意大利血小板 PRT 使用持续增加的成本。
成立了一个多学科团队来进行 HTA 并进行预算影响分析。血小板使用的定量数据来自 2015 年国家血液输血报告和意大利血小板输血评估研究（IPTAS）。目前，每个血小板 PRT 程序 60 欧元的国家费用用于量化意大利国家卫生服务（INHS）的成本。该分析采用 3 年时间框架。为了确定对预算的影响，我们将代表随着时间的推移 PRT 血小板使用增加的情景与使用标准血小板的对照情景进行了比较。
PRT 在 20%、40%和 66%的年度成人血小板剂量中的逐步实施可能会使 INHS 的年度成本增加约 7、14 和 2300 万欧元。使用适合在一次 PRT 过程中治疗多个成人血小板剂量的试剂盒和设备可以降低成本。
为了全面评估实施血小板 PRT 的社会效益，必须权衡预期效益（预防输血传播感染、白细胞灭活、血小板储存延长、停止病原体检测测试）增加的成本。需要在地方一级基于实际血小板输血并发症数量及其社会成本进行进一步研究，以了解血小板 PRT 在意大利实施的全部成本效益比，并促进所有公民的平等待遇。
