The cost-effectiveness of reducing donor exposures with single-donor versus pooled random-donor platelets

BACKGROUND: Single-donor platelets (SDPs) are frequently preferred over poo led random-donor platelets (RDPs) to reduce donor exposures and the risk fo r virus transmission or HLA alloimmunization. Transfusion-associated virus- transmission risks have significantly decreased, which suggests that white cell reduction by filtration eliminates any difference in the risk of alloi mmunization in transfused leukemic patients. Health care reform pressures o f make it appropriate to examine the cost-effectiveness of SDPs Versus RDPs in reducing donor exposures. STUDY DESIGN AND METHODS: A decision analysis model was developed and sensi tivity analyses were used to assess the incremental cost (dollars/quality-a djusted life-year) associated with the use of SDPs Versus RDPs for adult pa tients undergoing hematopietic progenitor cell transplantation or primary c oronary artery bypass grafting (CABG). RESULTS: Among transplant patients, the incremental cost of choosing SDPs a s apposed to RDPs ranged from $168,700 to $519,822 per quality-adjusted lif e-year. For patients undergoing primary CABG, the incremental cost was $192 ,415 (females) and $216,280 (males). Variations in the cost differential be tween SDPs and RDPs the number of random-donor platelets in the RDP, and th e risk of bacterial sepsis markedly influenced cost-effectiveness. The mode l was minimally affected by variations in the risks of transmission of HIV and hepatitis B and C, and human T-lymphotropic viruses. CONCLUSION: In comparison with other accepted medical interventions, the us e of SDPs as apposed to RDPs may not be a cost-effective method of reducing donor exposures in the adult patient populations studied. SDPs were more c ost-effective in patients undergoing primary GABG than in leukemia patients undergoing hematopoietic progenitor cell transplantation. Regardless of di agnosis, decreasing the acquisition cost differential would have the greate st impact on improving the cost-effectiveness of SDPs, as opposed to RDPs, to decrease donor exposures.