Outpatient red blood cell transfusion payments among patients on chronic dialysis

BMC Nephrology

Akhtar Ashfaq³  Shaowei Wan³  Helen V Varker⁴  Katherine A Cappell⁴  Zhun Cao⁴  Brian S Custer²  Xue Song⁴  Jeffrey L Carson¹  David M Spiegel⁵  J Andrew Lee³  Matthew Gitlin³ 

[1] UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA;Blood Systems Research Institute, San Francisco, CA, USA;Amgen, Inc., One Amgen Center Drive, Thousand Oaks, CA, USA;Truven Health Analytics, Cambridge, MA, USA;University of Colorado, Denver, CO, USA

关键词: Cost;    Payers;    Red blood cell transfusions;    Dialysis;   

Others  :  1083066
DOI  :  10.1186/1471-2369-13-145

 received in 2012-03-21, accepted in 2012-10-28,  发布年份 2012

【 摘 要 】

Background

Payments for red blood cell (RBC) transfusions are separate from US Medicare bundled payments for dialysis-related services and medications. Our objective was to examine the economic burden for payers when chronic dialysis patients receive outpatient RBC transfusions.

Methods

Using Truven Health MarketScan® data (1/1/02-10/31/10) in this retrospective micro-costing economic analysis, we analyzed data from chronic dialysis patients who underwent at least 1 outpatient RBC transfusion who had at least 6 months of continuous enrollment prior to initial dialysis claim and at least 30 days post-transfusion follow-up. A conceptual model of transfusion-associated resource use based on current literature was employed to estimate outpatient RBC transfusion payments. Total payments per RBC transfusion episode included screening/monitoring (within 3 days), blood acquisition/administration (within 2 days), and associated complications (within 3 days for acute events; up to 45 days for chronic events).

Results

A total of 3283 patient transfusion episodes were included; 56.4% were men and 40.9% had Medicare supplemental insurance. Mean (standard deviation [SD]) age was 60.9 (15.0) years, and mean Charlson comorbidity index was 4.3 (2.5). During a mean (SD) follow-up of 495 (474) days, patients had a mean of 2.2 (3.8) outpatient RBC transfusion episodes. Mean/median (SD) total payment per RBC transfusion episode was $854/$427 ($2,060) with 72.1% attributable to blood acquisition and administration payments. Complication payments ranged from mean (SD) $213 ($168) for delayed hemolytic transfusion reaction to $19,466 ($15,424) for congestive heart failure.

Conclusions

Payments for outpatient RBC transfusion episodes were driven by blood acquisition and administration payments. While infrequent, transfusion complications increased payments substantially when they occurred.

【 授权许可】

   
2012 Gitlin et al.; licensee BioMed Central Ltd.

【 图 表 】

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