Abstract

BACKGROUND Technologies used in the processing of whole blood and blood component products, including pathogen reduction, are continuously being adopted into blood transfusion workflows to improve process efficiencies. However, the economic implications of these technologies are not well understood. With the advent of these new technologies and regulatory guidance on bacterial risk-control strategies, an updated systematic literature review on this topic was warranted. OBJECTIVE The objective of this systematic literature review was to summarize the current literature on the economic analyses of pathogen-reduction technologies (PRTs). METHODS A systematic literature review was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines to identify newly published articles in PubMed, MEDLINE Complete, and EconLit from 1 January 2000 to 17 July 2019 related to economic evaluations of PRTs. Only full-text studies in humans published in English were included in the review. Both budget-impact and cost-effectiveness studies were included; common outcomes included cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). RESULTS The initial searches identified 433 original abstracts, of which 16 articles were included in the final data extraction and reporting. Seven articles presented cost-effectiveness analyses and nine assessed budget impact. The introduction of PRT increased overall costs, and ICER values ranged widely across cost-effectiveness studies, from below $US150,000/QALY to upwards of $US20,000,000/QALY. This wide range of results was due to a multitude of factors, including comparator selection, target patient population, and scenario analyses included. CONCLUSIONS Overall, the results of economic evaluations of bacterial risk-control strategies, regardless of mechanism, were highly dependent on the current screening protocols in place. The optimization of blood transfusion safety may not result in decisions made at the willingness-to-pay thresholds commonly seen in pharmaceutical evaluations. Given the critical public health role of blood products, and the potential safety benefits introduced by advancements, it is important to continue building this body of evidence with more transparency and data source heterogeneity. This updated literature review provides global context when making local decisions for the coverage of new and emerging bacterial risk-control strategies.

Abstract

Although research on blood donation abounds, no studies have yet attempted to estimate the socio-economic value generated from Blood Donors Associations (BDAs). To fill this gap, the authors ran a Social Return on Investment (SROI) analysis on four units of the largest BDA in Italy, the Association of Voluntary Italian Blood Donors ("Avis"). This study used multiple methods for data collection and analysis. A systematic literature review helped the identification of proper financial proxies to highlight the economic value of the social and health impacts experienced by Avis members. A focus group with key informants gathered their views on the areas of impact selected for the analysis: early detection of diseases, adoption of healthier lifestyles, social capital, human capital, personal satisfaction and reinforcement of a 'giving culture'. Primary data collection involved (a) an Activity Based Costing analysis (b) a self-reported questionnaire to 1.066 BDA members and unassociated donors enabling the comparison of the blood donation experience of these two groups. The SROI analysis resulted in four positive ratios, varying between euro1.70 and euro13.80. This study contributes to the knowledge on impact evaluations in TSOs. Policy implications refer to BDAs deserving financial and material support for their capacity to generate positive social impacts.