Cost-effectiveness of a limited-donor blood program for neonatal red cell transfusions

BACKGROUND: Very-low-birthweight infants have typically been given fresh re d cells (RBCs), a practice in which aliquots of RBCs for several infants we re issued each day from a single unit. Recently, to limit donor exposures, large volumes of RBCs are reserved for the long-term transfusion support of individual infants. STUDY DESIGN AND METHODS: Medical records were examined retrospectively to assess the costs of a limited-donor program for providing RBC transfusions to very-low-birthweight infants. Costs of multiple- and limited-donor progr ams were compared by using two samples of 30 consecutive infants treated at The University of lowa Hospitals and Clinics in 1993 and 1997. Effectivene ss was evaluated with respect to the number of donor exposures per infant. RESULTS: The cost, in 1997 dollars, of preparing each small-volume transfus ion in the multiple-donor program was $27.86 per transfusion, while that in the limited-donor program was $34.83. This difference was largely attribut able to use of white cell reduction in association with the limited-donor p rogram in 1997. Eliminating the costs associated with white cell reduction rendered the costs of the limited- and multiple-donor transfusions comparab le. The limited-donor program had donor exposures of 2.0 per infant, while the multiple-donor program had 3.6 exposures per infant (p<0.002). CONCLUSION: The limited-donor blood program reduces donor exposure without adversely affecting costs.