OBJECTIVES

The intent of this research was to identify the costs occurred per stakeholder in the treatment of sickle cell disease (SCD) within England and France. Moreover we wanted to understand differences in terms of costs, depending on the transfusion modality. We wanted to compare the following transfusion types: Automated red blood cell exchange (aRBCX), Top-up transfusion (TU) and Manual red blood cell exchange (mRBCX).

METHODS

By means of literature review we constructed a de novo economic model that maps the direct treatment costs (e.g. cost of blood), indirect treatments costs (e.g. chelation therapy), cost of disease complications (e.g. hospital stay) and costs of lives lost. Next these costs were distributed over four stakeholders: apheresis centers, other hospital wards (e.g. intensive care), patients and society.

RESULTS

Yearly SCD may cost 108000 USD. 7% Of these costs are occurred by the apheresis unit, up to 80% are experienced by other wards, 2% are carried by patients and 11% are carried by society. The cost of complications represents the largest proportion: 55%. Direct treatment cost represents 7%. The transfusion modality largely influences the total cost of illness. The most expensive option from a direct treatment point of view is aRBCX:13000 USD per year whereas TU costs 6.000 USD per year. However, from a total cost of illness point of view, aRBCX costs 68000 USD per year whereas mRBCX and TU come in at 90000 and 174000 USD per year. aRBCX comes with relatively high costs for apheresis centers whereas the other transfusion types come with higher costs for other hospital departments, patients and society.

CONCLUSIONS

In the evaluation of the total cost of illness of SCD, the stakeholder perspective applied, and costs considered largely influence the relative cost position of different transfusion modalities. When considering all cost drivers, aRBCX is cost efficient versus other transfusion modalities.