BACKGROUND: Large volume delayed sampling (LVDS) and pathogen reduction technology (PRT) are two strategies for platelet processing to control risk of contamination prior to transfusion. LVDS and PRT have different processing methods and result in platelets having different risks, viability, and shelf life. Each of which can affect platelet costs and availability to the healthcare system.
AIMS: This study compares the economic and clinical impact of LVDS and PRT strategies while considering a holistic view of processing/testing through patient treatment.
METHODS: A decision model was constructed to simulate the collection, processing, and use of platelets for four platelet processing strategies: PRT with shelf life of 5 days (PRT5), PRT with shelf life of 7 days (PRT7), LVDS with shelf life of 7 days (LVDS7), and LVDS with initial shelf life of 5 days extended to 7 days with secondary testing (LVDS5/2). Target population were adults requiring two or more transfusions such as patients with hemato-oncological disease or receiving hemopoietic stem cell transplantation. Platelet collection, processing, storage, and distribution data were obtained from the National Blood Collection and Utilization Survey and published literature. Patient outcomes associated with transfusions (adverse events, number of units needed per transfusion, total number of transfusions needed, interval between transfusions, and platelet counts resulting from transfusing) were obtained from AABB guidelines, meta-analyses, and other published clinical studies. Per patient reimbursement costs (2020 USD) were obtained from reimbursement schedules and other published sources.
RESULTS: Based on shelf life and average contamination and expiration rates, for 10,000 donated platelet units, 9,512, 9,878, 9,511, and 9,651 units of PRT5, PRT7, LVDS5/2, and LVDS7 platelets would be available for transfusion, respectively. With these units, 1,502, 1,560, 2,172, and 2,329 corresponding transfusions can be performed where platelet-related adverse events are expected to occur 10.7%, 10.7%, 10.1%, and 10.1% of the time. Hospitals will need to have 72,882, 70,181, 50,406, and 47,022 PRT5, PRT7, LVDS5/2, and LVDS7 platelet units on hand in order to fulfill transfusion demand in a year. The resulting per-patient reimbursement cost per transfusion and per transfusion cycle is higher with PRT units.
