TY - JOUR
T1 - Economic evaluation of a hypothetical screening assay for alloimmunization risk among transfused patients with sickle cell disease
AU - Kacker, Seema
AU - Ness, Paul M.
AU - Savage, William J.
AU - Frick, Kevin D.
AU - Shirey, R. Sue
AU - King, Karen Eileen
AU - Tobian, Aaron A.R.
PY - 2014/8
Y1 - 2014/8
N2 - Background 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. Study Design and Methods 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%). Results 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. Conclusions A sufficiently specific assay to inform antigen-matching may be cost-effective in reducing alloimmunization among transfused patients with SCD.
AB - Background 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. Study Design and Methods 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%). Results 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. Conclusions A sufficiently specific assay to inform antigen-matching may be cost-effective in reducing alloimmunization among transfused patients with SCD.
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U2 - 10.1111/trf.12585
DO - 10.1111/trf.12585
M3 - Article
C2 - 24571485
AN - SCOPUS:84906222827
SN - 0041-1132
VL - 54
SP - 2034
EP - 2044
JO - Transfusion
JF - Transfusion
IS - 8
ER -