Economic evaluation of a hypothetical screening assay for alloimmunization risk among transfused patients with sickle cell disease. Issue 8 (27th February 2014)

• Record Type: Journal Article
• Authors: Kacker, Seema; Ness, Paul M.; Savage, William J.; Frick, Kevin D.; Shirey, R. Sue; King, Karen E.; Tobian, Aaron A.R.
• Is Part Of: Transfusion. Volume 54:Issue 8(2014)
• Page Start: 2034
• Page End: 2044
• Publication Date: 2014-02-27
• Subjects: Hematology -- Periodicals; Blood -- Transfusion -- Periodicals; Blood Group Antigens -- Periodicals; Blood Preservation -- Periodicals; Blood Transfusion -- Periodicals; 615
• DOI: 10.1111/trf.12585
• Languages: English
• ISSNs: 0041-1132

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="trf12585-sec-0001" sec-type="section"> <title>Background</title> <p>Prophylactic antigen‐matching can reduce alloimmunization rates among chronically transfused patients with sickle cell disease (SCD), but this matching increases costs and may only benefit 30% of patients. We assessed the clinical and financial value of a potential assay for alloimmunization risk that would allow for targeted antigen‐matching.</p> </sec> <sec id="trf12585-sec-0002" sec-type="section"> <title>Study Design and Methods</title> <p>A Markov‐based model evaluated direct medical costs and alloimmunization events over 10 to 20 years among transfused (simple or exchange) patients with SCD. Four matching strategies were evaluated: prospective matching (for all patients), history‐based matching (only for patients with prior alloimmunization), perfectly informed matching (assay with 100% sensitivity, 100% specificity), and imperfectly informed matching (reduced accuracy). Under all matching protocols, matching included C, E, K, and any additional alloantibodies present. A hospital perspective was adopted, with costs (2012US$) and events discounted (3%).</p> </sec> <sec id="trf12585-sec-0003" sec-type="section"> <title>Results</title> <p>Perfectly informed antigen‐matching using a $1000 assay is expected to save $82, 334 per patient over 10 years, compared to prospective matching. Perfectly informed antigen‐matching is more costly than history‐based matching, but reduces alloimmunization events by 45.6% over 10 years. Averting each alloimmunization event using this strategy would cost an additional $10, 934 per patient. Imperfectly informed antigen‐matching using an assay with 75% specificity and 75% sensitivity is less costly than prospective matching, but increases alloimmunization events. Compared to history‐based matching, imperfectly informed matching would decrease alloimmunization events by 32.61%, at an additional cost of $147, 915 per patient over 10 years. Cost‐effectiveness of informed antigen‐matching is largely driven by assay specificity.</p> </sec> <sec id="trf12585-sec-0004" sec-type="section"> <title>Conclusions</title> <p>A sufficiently specific assay to inform antigen‐matching may be cost‐effective in reducing alloimmunization among transfused patients with SCD.</p> </sec> </abstract>