Costs to Hospitals of Acquiring and Processing Blood in the US: A Survey of Hospital-Based Blood Banks and Transfusion Services

By Toner, Richard W.; Pizzi, Laura et al. | Applied Health Economics and Health Policy, January 2011 | Go to article overview

Costs to Hospitals of Acquiring and Processing Blood in the US: A Survey of Hospital-Based Blood Banks and Transfusion Services


Toner, Richard W., Pizzi, Laura, Leas, Brian, Ballas, Samir K., Quigley, Alyson, Goldfarb, Neil I., Applied Health Economics and Health Policy


Background

'Safety at all costs' remains the societal position on the importance of a safe blood supply. However, the cost-accounting and reimbursement system behind the acquisition, screening and transfusion of blood is largely obscure, perhaps even more so than US healthcare financing in general. This obscurity is troublesome given that 14 650 000 units of whole blood and red blood cells (RBCs) were transfused in the US in 2006.[1]

A 2003 Transfusion editorial[2] suggested that enhancing transfusion safety was contingent upon fixing a broken reimbursement system for transfusion services. The editorial stated that payment rates for blood components and services "frequently lag far behind the actual cost of procuring state-of-the-art blood components and services." In the same issue, Goodman et al.[3] noted that the ability of the Medicare Prospective Payment System (PPS) to accurately account for increasing costs depended on the quality of cost and charge data reported by hospitals to Medicare. Unfortunately, as of 2002, only half of US hospitals coded for blood components, limiting the quality of data available to Medicare.[2,3] Thus, inadequate data reporting propagates an inadequate cost-accounting system. The cost-accounting issues are thoroughly vetted in write-ups by Ness,[2] Goodman et al.[3] and Liberman and Rotarius.[4]

Past research efforts, in the US and internationally, have examined the costs related to blood collection and transfusion.[5-13] More recent efforts in the last decade have focused on building consensus around the activities, materials and services that should be included in calculating a true, societal cost of blood.[3,14,15] Factors include (but are not limited to) donor recruitment and qualification, blood collection, processing, lab testing, transportation, storage, pre-transfusion preparation, transfusion administration and follow-up, and long-term outcomes tracking.[14,15] Although these efforts have laid the conceptual foundation for a more accurate system, quantitative cost data supplied by stakeholders (e.g. hospitals) will be needed for each step of the model.

One such cost is the price paid by hospitals to blood centres and collection facilities per unit of RBCs. This cost represents an aggregation of costs incurred by the blood collection facility for services involved with donor recruitment, blood collection, processing and (most often) laboratory testing. A report by the Lewin Group found that the cost to blood collection centres for collection, recruitment, testing, distribution and general operation each increased by double-digit percentages from 1996 to 2000.[3] These costs led to a 31% increase from 2001 to 2004 in the price hospitals paid for units of RBCs.[16]

Currently, the best source of data on acquisition costs is the National Blood Collection and Utilization Survey (NBCUS), a biennial survey of hospitals, blood centres and cord blood banks, conducted by the American Association of Blood Banks (AABB) and funded by the US Department of Health and Human Services.[1,16] Although it only provides data on acquisition cost, the NBCUS is the only publicly available source of economic data on blood. The 2005 NBCUS[16] reported that the average amount paid by hospitals per unit of leukocyte-reduced, non-irradiated (O positive) RBCs was $US121.98 in 1999, $US153.68 in 2001 (26% increase from 1999) and $US201.07 in 2004 (31% increase from 2001). The most recent survey,[1] released in 2008 with data from 2006, found the price of leukocyte-filtered RBCs to be $US213.94 (6.4% increase from 2004).

Except for this biennial survey, there are no nationally representative data on the acquisition costs to hospitals for blood components when purchased from a supplier in the US. Furthermore, the NBCUS does not report costs related to the processing of blood components after acquisition and prior to transfusion. A more recent and complete picture of these acquisition and processing costs borne by hospitals is necessary to support efforts in the field to develop a stable and fair financing system. …

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