OBJECTIVES: ARCET is a complex procedure and a main treatment for patients with SCD who require regular transfusion therapy (RTT).

Therefore, we aimed to estimate costs of ARCET amongst patients with SCD receiving RTT within a retrospective cohort study in the English National Health Service (NHS).

METHODS: We identified 391 (5.1%) patients receiving RTT (≥6 red blood cells [RBCs] transfusions in 12 months) amongst 7,662 patients with SCD aged ≥12 from the Clinical Practice Research Datalink Aurum linked with Hospital Episode Statistics from 2007-2019.

Assumptions: Patients receiving RTT were eligible for ARCET starting from fulfillment of RTT criteria. ARCET continued as 6-weekly sessions with 12.2 RBC units per session until patient censor. Patients starting ARCET during follow-up incurred a one-time cost for subcutaneous dual-lumen port insertion (SCPi).

We obtained costs for ARCET and SCPi from the National Schedule of NHS Costs 2018-19. ARCET cost £1,821, exclusive of blood products. SCPi cost £1,686 for ≥19 years and £2,915 for <19 years. A unit of RBCs cost £205.17 (NHSBT price list 2018-19).

RESULTS: We estimated an annualized median of 8.8 (IQR 8.7 – 9.0) ARCET sessions per person per year (pppy) (mean [SD] 9.7 [9.0]) over median time of 4.67 years. Annualized mean(SD) cost was £20,103 (£33,775), including the cost of port insertion and excluding the cost of machine purchase and maintenance and blood products. The annual cost of RBCs was £22,027, giving an estimated mean annual cost for ARCET of £42,130 per patient.

CONCLUSIONS: The estimated annual ARCET costs are substantial and should be appropriately reflected in economic analyses to inform decisions related to SCD management. This analysis used a top-down costing approach which did not include the cost of complications related to ARCET; these should be considered separately if used in economic modeling.