The costs of transfusion: economic evaluations in transfusion medicine, P art 1

I t’s not surprising that health care costs are increasingly overwhelming individuals, communities, and governments. National health spending in the United States is expected to grow at an average rate of 5.7% annually during the period between 2011 and 2021. Furthermore, since health care spending is increasing at a faster rate than overall gross domestic product, health care as a portion of gross domestic product is expected to increase to 19.6% by 2021. The field of transfusion medicine has not been isolated from these changes. Blood transfusion costs have increased dramatically over the past two decades, due in part to increased demand, increased utilization of risk-reduction methods, and the development and implementation of new technologies for donation and transfusion. The portion of total hospital costs attributable to blood transfusion varies by disease and procedure, with transfusion representing 1% or less of total costs for most conditions. Transfusion plays a more substantial financial role (5%-9% of total hospital costs) for other medical treatments, however, including liver and bone marrow transplantation. The total cost of blood transfusion for these treatments can easily exceed $3800. Although these increases are likely attributable to multiple factors, one approach to cost containment has been a growing use of economic evaluation. The health and financial outcomes generated from these types of analyses are helpful in developing and evaluating the impact of health programs and policies. In the field of transfusion medicine, these studies help clinicians and policymakers maximize efficiency and patient benefit while minimizing cost. In a series of four review articles, we will introduce and discuss the concepts and motivation behind conducting and interpreting economic analyses relevant to transfusion medicine. In the first of these articles, we provide an overview of costing methods in the context of transfusion medicine and discuss the purpose behind conducting economic evaluations. In the second and third articles, we introduce a hypothetical situation where economic analysis would be useful and discuss the process of defining an analytic framework, using this example to provide insight into the considerations and input parameters required for alternative evaluation methods. Finally, in the fourth article, we discuss data generated from economic evaluations and approaches to interpretation of these analyses in the field of transfusion medicine.