Transfusion medicine

Extra safety for platelets comes at a cost

Cost effectiveness will be the sticking point for pathogen inactivation or reduction technologies for platelets, the Blood 2018 conference has been told.

And while systems such as Intercept and Mirasol may be effective against infectious and possibly non-infectious threats such as transfusion-associated graft versus host disease (GVHD), operational gains were unlikely to offset the investment costs.

Professor Brian Custer, Director of Epidemiology and Health Policy Science at the Vitalant Research Institute in the US, told delegates pathogen inactivation of platelets would cost about $1 million per quality-adjusted life year (QALY).

If the technology replaced other interventions such as bacterial cultures, the figure might come down to about $250,000 per QALY.

“This is not enough support for cost-effectiveness,” he said.

Despite this, about 70 centres in the US had the capacity to implement Intercept and ‘the stage is set to see much greater use’.

The system is also in use in countries such as France, Switzerland and Belgium where post-market surveillance showed there had been no transfusion-transmitted infections or transfusion-associated GVHD.

While data on Mirasol was more limited, Professor Custer said there had been no bacterial contamination or sepsis, no serious adverse effects and no increase in bleeding.

He said while there had been some initial concerns about the potential toxic effects of amotosalen/UVA in Intercept or riboflavin/UVB in Mirasol, there was no data to support those concerns.

Pathogen inactivation technology was particularly appealing in light of emerging pathogens which could cause transfusion-transmitted infection before authorities were aware of new risks or be able to respond in terms of testing.

Speaking at the ANZSBT session on product safety Professor Custer said he knew Australia already had interventions in place to try to reduce risk associated with platelets.

“What I do not know is how often that might fail or if there might be a problem. And it’s really considerations like that that might lead you to go down that path of deciding whether pathogen inactivation is the right thing to do.”

He said it was possible to use pathogen inactivation technologies in particular patient populations at very high risk for certain events and have separate inventories.

“I’m not sure ARCBS wants to do that; it’s very complex but one of the options is to incrementally introduce the technologies for people that are at higher risk – for example related to GVHD.”

“The question around that is when you look at the non-infectious threats; again, how frequent are they? The Australian supply is completely leucodepleted so there is a small residual white cell count but it is still there and so it could potentially cause allergic reactions or something more severe.”

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