Background/Case Studies: Large volume delayed sampling (LVDS) and pathogen reduction technology (PRT) are two strategies for platelet processing to control risk of contamination prior to transfusion. LVDS and PRT have different processing methods, risks, and impact on platelet shelf life that can affect platelet costs and availability to the healthcare system. This study compares the economic and clinical impact of LVDS and PRT strategies.
Study Design/Methods: A decision model was constructed to simulate the collection, processing, and use of platelets for three platelet processing strategies: PRT with shelf life of 5 days, LVDS with shelf life of 7 days (LVDS7), and LVDS with initial shelf life of 5 days extended to 7 days with secondary testing (LVDS5/2). Target population were adults requiring two or more transfusions such as patients with hemato-oncological disease or receiving hemopoietic stem cell transplantation. Platelet collection, processing, storage, and distribution data were obtained from the National Blood Collection and Utilization Survey and published literature. Patient outcomes associated with transfusions (adverse events, number of units needed per transfusion, total number of transfusions needed, interval between transfusions, and platelet counts resulting from transfusing) were obtained from AABB guidelines, meta-analyses, and other published clinical studies. Center and hospital-specific costs (2020 USD) were obtained from reimbursement schedules and other published sources.
Results/Findings: Based on shelf life and average contamination and expiration rates, for 10,000 donated platelet units, 9,024, 9,511, and 9,752 units of PRT, LVDS5/2, and LVDS7 platelets would be available for transfusion, respectively. With these units, 1,425, 2,172, and 2,353 corresponding transfusions can be performed where platelet-related adverse events are expected to occur 10.7%, 10.1%, and 10.1% of the time. The resulting mean cost per transfusion and per transfusion cycle is higher with PRT units.
Conclusions: The findings of this holistic view of platelet processing show that compared to PRT, LVDS strategies are associated with lower costs and higher platelet availability for transfusions while patients experience similar levels of adverse events. Increased utilization of LVDS has the potential to improve efficiency, patient access to platelets, and reduce healthcare costs.
