Economic evaluation of a hypothetical screening assay for alloimmunization risk among transfused patients with sickle cell disease

Seema Kacker, Paul Michael Ness, William J. Savage, Kevin Frick, R. Sue Shirey, Karen Eileen King, Aaron A Tobian

Research output: Contribution to journalArticle

Abstract

Background Prophylactic antigen-matching can reduce alloimmunization rates among chronically transfused patients with sickle cell disease (SCD), but this matching increases costs and may only benefit 30% of patients. We assessed the clinical and financial value of a potential assay for alloimmunization risk that would allow for targeted antigen-matching. Study Design and Methods A Markov-based model evaluated direct medical costs and alloimmunization events over 10 to 20 years among transfused (simple or exchange) patients with SCD. Four matching strategies were evaluated: prospective matching (for all patients), history-based matching (only for patients with prior alloimmunization), perfectly informed matching (assay with 100% sensitivity, 100% specificity), and imperfectly informed matching (reduced accuracy). Under all matching protocols, matching included C, E, K, and any additional alloantibodies present. A hospital perspective was adopted, with costs (2012US) and events discounted (3%). Results Perfectly informed antigen-matching using a 1000 assay is expected to save 82,334 per patient over 10 years, compared to prospective matching. Perfectly informed antigen-matching is more costly than history-based matching, but reduces alloimmunization events by 45.6% over 10 years. Averting each alloimmunization event using this strategy would cost an additional 10,934 per patient. Imperfectly informed antigen-matching using an assay with 75% specificity and 75% sensitivity is less costly than prospective matching, but increases alloimmunization events. Compared to history-based matching, imperfectly informed matching would decrease alloimmunization events by 32.61%, at an additional cost of 147,915 per patient over 10 years. Cost-effectiveness of informed antigen-matching is largely driven by assay specificity. Conclusions A sufficiently specific assay to inform antigen-matching may be cost-effective in reducing alloimmunization among transfused patients with SCD.

Original languageEnglish (US)
Pages (from-to)2034-2044
Number of pages11
JournalTransfusion
Volume54
Issue number8
DOIs
StatePublished - 2014

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Sickle Cell Anemia
Cost-Benefit Analysis
Antigens
Costs and Cost Analysis
History
Isoantibodies
Sensitivity and Specificity

ASJC Scopus subject areas

  • Hematology
  • Immunology
  • Immunology and Allergy

Cite this

Economic evaluation of a hypothetical screening assay for alloimmunization risk among transfused patients with sickle cell disease. / Kacker, Seema; Ness, Paul Michael; Savage, William J.; Frick, Kevin; Shirey, R. Sue; King, Karen Eileen; Tobian, Aaron A.

In: Transfusion, Vol. 54, No. 8, 2014, p. 2034-2044.

Research output: Contribution to journalArticle

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title = "Economic evaluation of a hypothetical screening assay for alloimmunization risk among transfused patients with sickle cell disease",
abstract = "Background Prophylactic antigen-matching can reduce alloimmunization rates among chronically transfused patients with sickle cell disease (SCD), but this matching increases costs and may only benefit 30{\%} of patients. We assessed the clinical and financial value of a potential assay for alloimmunization risk that would allow for targeted antigen-matching. Study Design and Methods A Markov-based model evaluated direct medical costs and alloimmunization events over 10 to 20 years among transfused (simple or exchange) patients with SCD. Four matching strategies were evaluated: prospective matching (for all patients), history-based matching (only for patients with prior alloimmunization), perfectly informed matching (assay with 100{\%} sensitivity, 100{\%} specificity), and imperfectly informed matching (reduced accuracy). Under all matching protocols, matching included C, E, K, and any additional alloantibodies present. A hospital perspective was adopted, with costs (2012US) and events discounted (3{\%}). Results Perfectly informed antigen-matching using a 1000 assay is expected to save 82,334 per patient over 10 years, compared to prospective matching. Perfectly informed antigen-matching is more costly than history-based matching, but reduces alloimmunization events by 45.6{\%} over 10 years. Averting each alloimmunization event using this strategy would cost an additional 10,934 per patient. Imperfectly informed antigen-matching using an assay with 75{\%} specificity and 75{\%} sensitivity is less costly than prospective matching, but increases alloimmunization events. Compared to history-based matching, imperfectly informed matching would decrease alloimmunization events by 32.61{\%}, at an additional cost of 147,915 per patient over 10 years. Cost-effectiveness of informed antigen-matching is largely driven by assay specificity. Conclusions A sufficiently specific assay to inform antigen-matching may be cost-effective in reducing alloimmunization among transfused patients with SCD.",
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AU - Shirey, R. Sue

AU - King, Karen Eileen

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N2 - Background Prophylactic antigen-matching can reduce alloimmunization rates among chronically transfused patients with sickle cell disease (SCD), but this matching increases costs and may only benefit 30% of patients. We assessed the clinical and financial value of a potential assay for alloimmunization risk that would allow for targeted antigen-matching. Study Design and Methods A Markov-based model evaluated direct medical costs and alloimmunization events over 10 to 20 years among transfused (simple or exchange) patients with SCD. Four matching strategies were evaluated: prospective matching (for all patients), history-based matching (only for patients with prior alloimmunization), perfectly informed matching (assay with 100% sensitivity, 100% specificity), and imperfectly informed matching (reduced accuracy). Under all matching protocols, matching included C, E, K, and any additional alloantibodies present. A hospital perspective was adopted, with costs (2012US) and events discounted (3%). Results Perfectly informed antigen-matching using a 1000 assay is expected to save 82,334 per patient over 10 years, compared to prospective matching. Perfectly informed antigen-matching is more costly than history-based matching, but reduces alloimmunization events by 45.6% over 10 years. Averting each alloimmunization event using this strategy would cost an additional 10,934 per patient. Imperfectly informed antigen-matching using an assay with 75% specificity and 75% sensitivity is less costly than prospective matching, but increases alloimmunization events. Compared to history-based matching, imperfectly informed matching would decrease alloimmunization events by 32.61%, at an additional cost of 147,915 per patient over 10 years. Cost-effectiveness of informed antigen-matching is largely driven by assay specificity. Conclusions A sufficiently specific assay to inform antigen-matching may be cost-effective in reducing alloimmunization among transfused patients with SCD.

AB - Background Prophylactic antigen-matching can reduce alloimmunization rates among chronically transfused patients with sickle cell disease (SCD), but this matching increases costs and may only benefit 30% of patients. We assessed the clinical and financial value of a potential assay for alloimmunization risk that would allow for targeted antigen-matching. Study Design and Methods A Markov-based model evaluated direct medical costs and alloimmunization events over 10 to 20 years among transfused (simple or exchange) patients with SCD. Four matching strategies were evaluated: prospective matching (for all patients), history-based matching (only for patients with prior alloimmunization), perfectly informed matching (assay with 100% sensitivity, 100% specificity), and imperfectly informed matching (reduced accuracy). Under all matching protocols, matching included C, E, K, and any additional alloantibodies present. A hospital perspective was adopted, with costs (2012US) and events discounted (3%). Results Perfectly informed antigen-matching using a 1000 assay is expected to save 82,334 per patient over 10 years, compared to prospective matching. Perfectly informed antigen-matching is more costly than history-based matching, but reduces alloimmunization events by 45.6% over 10 years. Averting each alloimmunization event using this strategy would cost an additional 10,934 per patient. Imperfectly informed antigen-matching using an assay with 75% specificity and 75% sensitivity is less costly than prospective matching, but increases alloimmunization events. Compared to history-based matching, imperfectly informed matching would decrease alloimmunization events by 32.61%, at an additional cost of 147,915 per patient over 10 years. Cost-effectiveness of informed antigen-matching is largely driven by assay specificity. Conclusions A sufficiently specific assay to inform antigen-matching may be cost-effective in reducing alloimmunization among transfused patients with SCD.

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