5567917 COST COMPARISON OF TRANSFUSION CHOICES IN OMAN FOR PATIENTS SUFFERING FROM SICKLE CELL DISEASE

Abstract

Background: Sickle cell disease(SCD) management can be challenging, requiring different therapeutic approaches because SCD could induce multiple complications. Red blood cell(RBC) transfusion is well known as one of the disease-modifying therapies available for long-term management. It’s supported by multiple randomized clinical trials for the prevention of disease complications such as stroke in adults and children with SCD.RBCs can be delivered via three methods: Simple transfusion(ST), manual exchange(ME) and automated red blood cell exchange(aRBCX). In ST, patients receive additional units of blood. The purpose is to raise the haemoglobin (Hb) to a steady state and maintain the oxygen-carrying capacity of blood. ME transfusion consists of removing the patient’s sickle-shaped RBCs and replacing them with healthy ones— lowering the concentration of sickled cells without increasing blood viscosity. This is performed using repeated alternating isovolumetric phlebotomy and blood transfusion. aRBCX involves removing sickled RBCs from the patient and rapid replacement with healthy RBCs while maintaining isovolemia. An advantage of aRBCX is the avoidance or minimization of costly iron chelation therapy to treat iron overload. Aim: SCD management is an important cost driver for health systems. The intent of this research was to compare the cost-effectiveness of different transfusion modalities. We wanted to compare the all-inclusive costs. and wanted to perform this evaluation in Oman, as the incidence of SCD ranges between 0.2% and 0.07%. This disease is considered one of Oman’s most common genetic blood disorders. Method: In-depth data about variables that drive costs have been collected to populate a de novo cost model. We collected data from the Royal Hospital and Sultan Qaboos University Hospital. Cost drivers that we took into consideration were disease incidence, cost of blood transfusion, medical equipment, disposables, cost of staff, complications, iron chelation therapy, hospitalization, and lives lost. The assessment took place in June 2020. The cost of the treatment intervention, cost of disease-related complications and the yearly cost of treatment imputable to each transfusion modality represented the most significant differences across the three transfusion choices. By populating the model with resources provided by the two above-mentioned hospitals, we could demonstrate the cost differences between transfusion choices and the potential benefits that healthcare providers can experience. The results demonstrate significant differences across cost parameters, such as Cost of treatment, Cost of treatment-related potential effect, Cost of complications, Cost of life years lost, and Estimated total yearly cost per patient. Results and conclusion: aRBCX promotes a reduction in overall resource utilization and improved patient outcomes. aRBCX is approximately 47% less costly than ST, and is approximately 23% less costly when compared to ME. By highlighting the consequence of treatment choice and its financial impact, we aim to support the adoption of aRBCX in comparison to alternative transfusion choices and validate future reimbursement considerations. aRBCX cost savings may lead to better adoption. We recommend researchers rerun these calculations with the model on an individual hospital basis.