Cost and Shelf-Life Implications of Pathogen-Reduced Platelets: A Hospital Budget Impact Model

FDA draft guidance has highlighted the need to reduce risk of platelet component (PC) bacterial contamination via pathogen reduction (PR) or secondary rapid testing (RT). Hospitals must understand resulting cost implications. Objective was to create an interactive model to analyze the budget impact of different PC types from the US hospital transfusion service perspective. An interactive, customizable Excel model was built and populated with base case costs and probabilities identified through literature search and a survey administered to 27 US hospital transfusion service directors. Three scenarios were generated to compare shelf-life and annual costs of platelet acquisition, testing, wastage, dispensing, transfusion, adverse events, and reimbursement for a hospital that purchases all of its PC: 100% conventional (C-PC), 100% PR-PC, and mix of 75% C-PC / 25% PR-PC. Model assumes 1) 8,164 platelet units purchased/year with a 5-day shelf-life; 2) 60.7% of C-PC irradiated and 6.4% of C-PC both cytomegalovirus (CMV)-tested and irradiated; 3) PR replaces irradiation, CMV testing, and bacterial detection (BD); 4) unit purchase costs were $524.00/C-PC, $602.60/C-PC irradiated, $623.00/C-PC both CMV-tested and irradiated, $603.75/PR-PC; 5) 26.3% of PC transfusions were outpatient (reimbursable). Total cost for 100% C-PC was $5,391,418 versus $5,561,336 for 100% PR-PC and $5,433,897 for mixed inventory. Outpatient reimbursements were $1,012,828 for 100% C-PC versus $1,075,363 for 100% PR-PC and $1,028,462 for mixed inventory. Maximum usable shelf-life was 48.0 hours for 100% C-PC versus 63.2 hours for 100% PR-PC and 51.8 hours for mixed inventory. Model predicts modest cost increase for PR-PC compared to C-PC depending on degree of PR conversion; this includes such cost offsets as elimination of BD and irradiation and decreased wastage due to increased shelf-life. Shelf-life may increase with PR due to BD elimination. This model can serve as an important tool for hospitals considering PR adoption.