PSY3 Disease Management of Patients with B-Thalassemia in Italy: Current and Future Perspectives

Abstract

This analysis aimed to assess the current patient pathway for adults with transfusion dependent β-thalassemia (TDBT), and to estimate the average annual costs associated with red blood cell (RBC) transfusions in the Italian hospital setting in 2019. The patient pathway was analyzed by leveraging Care Delivery Value Chain methodology, originally developed for healthcare assessment. The analysis highlights the activities, actors, and care settings involved in each step of the healthcare delivery process. Inputs for the model were gathered from a literature review of scientific articles, disease guidelines, and national legislation. The model was validated through 5 qualitative interviews with thalassemiologists (i.e. hematologists, internists, and pediatricians). In the cost analysis, a societal perspective was adopted and long-term complication costs were not considered. Resource consumption was estimated using a time-driven, activity-based costing approach; this was quantified using web surveys sent to 24 nurses and 24 thalassemiologists. Unit costs were identified using publicly available information, with the inclusion of indirect costs for patients and caregivers estimated using the human capital approach. Two critical points in the transfusion management process that may burden patients and caregivers emerged from this analysis: shortage of blood at specific times (i.e. summer and national holidays); and the number of hospital admissions required for each RBC transfusion – up to 3 per transfusion. It was estimated that the average annual costs of transfusion management for a patient with TDBT totaled EUR 21,586 (excluding iron chelation therapy), comprising EUR 17,092 for infusion and EUR 4,494 for RBC collection. This analysis identified potential areas of improvement in the transfusion-management process in Italy. The current patient pathway generates a significant burden for each stakeholder involved (i.e. patients, caregivers, and the health service). Improvements in the therapeutic approach could reduce the economic and organizational impacts of the current transfusion-management pathway.