Open Access Research article

Outpatient red blood cell transfusion payments among patients on chronic dialysis

Matthew Gitlin1*, J Andrew Lee1, David M Spiegel2, Jeffrey L Carson3, Xue Song4, Brian S Custer5, Zhun Cao4, Katherine A Cappell4, Helen V Varker4, Shaowei Wan1 and Akhtar Ashfaq1

Author Affiliations

1 Amgen, Inc., One Amgen Center Drive, Thousand Oaks, CA, USA

2 University of Colorado, Denver, CO, USA

3 UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA

4 Truven Health Analytics, Cambridge, MA, USA

5 Blood Systems Research Institute, San Francisco, CA, USA

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BMC Nephrology 2012, 13:145  doi:10.1186/1471-2369-13-145

Published: 2 November 2012

Abstract

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.

Keywords:
Dialysis; Red blood cell transfusions; Payers; Cost