OBJECTIVES: Chronic Liver Disease (CLD) management involves performance of minor and major invasive procedures (IPs). Associated severe thrombocytopenia (TCP), platelet count (PC) <50x10⁹/L, is common, with increased bleeding risk during IPs. This study estimates economic impact of managing patients with CLD-associated severe TCP undergoing IPs in Spain.

METHODS: Literature review from biomedical databases and grey literature. Interviews with 5 blood banks representatives. Delphi study, semi-structured, two-round consultation (32 clinical experts). Findings ratified face-to-face with 8 experts. Resource utilisation translated into unit costs using Spanish cost-databases.

RESULTS: CLD patients show great inter-patient variability. They undergo approximately 1 IP/year (range: 0,2-3). Platelet transfusions (PT) represent current standard of care to raise pre-IP PC, requiring hospitalisation. Platelets’ storage, manipulation, testing and administration by hospital specialists are associated with significant costs: platelet therapeutic units (PTUs) cost varies depending on obtention method: platelets-pool (250-450€), plateletpheresis (400-600€). The number of transfused PTUs varies between minor (1-3) and major (1-4) IPs, resulting in an estimated cost/patient/IP of 525.87-2,095.71€, including hospitalisation, administration and rescue therapy costs. Average cost of conducted IPs ranges from 140.09€ (dental-procedures) to 12,314.79€ (Trans-jugular intrahepatic portosystemic shunt). Lack of effectiveness including short-life of platelets transfused can cause IP cancellations and bleeding events (up to 25% of the time), representing a cost-opportunity loss for the system and potentially negatively impacting patient outcomes. Approximately 5% of scheduled IPs are cancelled each year because of patients’ failure to reach required pre-IP PC (≥50x10⁹/L). Between 5-15% of patients are estimated to be unfit to receive PTs. Approximately 2% of patients are treated off-label with thrombopoietin receptor agonists, associated with a maximum cost/patient/IP between 1,315.35-1,465.35€.

CONCLUSIONS: There is great variability in patient treatment requirements, resulting in cost differences across Spanish hospitals and regions. Management of CLD-associated severe TCP with PTs can be associated with a significant high healthcare burden.