Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.
Hematology Center, Karolinska University Hospital, Stockholm, Sweden.
Vox Sang. 2021 May;116(5):581-590. doi: 10.1111/vox.13034. Epub 2020 Nov 18.
Blood transfusion is a cornerstone therapy for many patients with myelodysplastic syndromes (MDS), but ranges from few to no transfusions to intensive transfusion therapy. To date, no large studies have described transfusion use or costs for patients with MDS, accounting for the range of disease severity.
A nationwide cohort study was conducted with all patients diagnosed with MDS in Sweden between 2008 and 2017, based on the Swedish MDS register and the Swedish part of the Scandinavian Donations and Transfusions Database 3 (SCANDAT3-S). Patients were followed from diagnosis until death, emigration, allogeneic hematopoietic stem cell transplantation or end of follow-up. Average cumulative transfusion count and costs over time were calculated, stratified by the revised international prognostic scoring system (IPSS-R) and age at diagnosis. Costs calculations used data on incident transfusions and laboratory testing and were divided into: direct material costs, direct labour costs and laboratory costs.
In total, 2311 patients were included in the cohort. In the first four years after diagnosis, patients in the very low IPSS-R category received on average 25 red cell (95% confidence interval, 20-32) and 4 (3-7) platelet transfusions. Conversely, patients in the very high-risk category received on average 171 (135-200) red cell and 66 (51-78) platelet transfusions. Correspondingly, transfusion costs ranged from $8805 ($6482-$11 625) to $80 106 ($61 460-$95 792).
Transfusion count and costs for patients with MDS increased markedly with IPSS-R risk category, but were similar across age groups. Transfusion costs were considerable for the highest IPSS-R risk categories.
输血是许多骨髓增生异常综合征（MDS）患者的基石治疗方法，但输血范围从很少到没有输血到强化输血治疗。迄今为止，尚无大型研究描述 MDS 患者的输血使用或费用，也没有考虑疾病严重程度的范围。
对 2008 年至 2017 年间在瑞典被诊断为 MDS 的所有患者进行了一项全国性队列研究，该研究基于瑞典 MDS 登记处和斯堪的纳维亚 3 号捐赠和输血数据库（SCANDAT3-S）的瑞典部分。患者从诊断开始随访，直至死亡、移民、异基因造血干细胞移植或随访结束。根据修订后的国际预后评分系统（IPSS-R）和诊断时的年龄，计算了随时间推移的平均累积输血计数和成本。成本计算使用了关于事件性输血和实验室检测的数据，并分为：直接材料成本、直接劳动成本和实验室成本。
共有 2311 例患者纳入该队列。在诊断后的前四年，极低的 IPSS-R 组患者平均接受 25 单位红细胞（95%置信区间，20-32）和 4 单位（3-7）血小板输血。相比之下，极高风险组患者平均接受 171 单位（135-200）红细胞和 66 单位（51-78）血小板输血。相应地，输血费用从 8805 美元（6482-11625 美元）到 80106 美元（61460-95792 美元）不等。
随着 IPSS-R 风险类别，MDS 患者的输血数量和成本显著增加，但在年龄组之间相似。对于最高的 IPSS-R 风险类别，输血费用相当可观。
