Direct costs of transfusion reactions - an expert judgement approach.
BACKGROUND AND OBJECTIVES
Despite increasingly meticulous haemovigilance reporting throughout the world, a systematic assessment of the cost of transfusion reactions is still lacking. This is partly caused by the fact that such an assessment requires a subjective expert assessment of the additional costs linked to the adverse reaction. Data on the cost of transfusion reactions could support decision-making regarding blood transfusion safety measures.


MATERIALS AND METHODS
Thirteen experts from nine hospitals were asked to estimate the additional care required following various types of transfusion reactions. Additional care was quantified as the proportion of reactions requiring care, and the amount of care required (e.g. hospitalization days, additional physician's time). Experts were also asked to provide, per type of transfusion reaction, an estimate of the proportion of transfusion reactions preventable. Structured quantitative expert elicitation methods were applied to obtain and combine expert estimates.


RESULTS
The estimated annual in-hospital cost of transfusion reactions in the Netherlands is €933 356 per year (€1.52 per transfusion). Two-thirds (64%) of these are incurred by non-serious transfusion reactions. Circulatory overload, TRALI and anaphylaxis clearly dominate the costs of serious adverse transfusion reactions (66% in total); non-haemolytic transfusion reactions incur 46% of the cost of non-serious transfusion reactions. Additional safety measures targeting circulatory overload and new antibody formation potentially offer the highest cost reduction.


CONCLUSION
In-hospital costs of transfusion reactions are substantial but contribute to less than 1% of the total cost of transfusion in the Netherlands. A considerable part of these costs (24%) might be preventable.
['Janssen|M P|MP|http://orcid.org/0000-0002-1682-7817', 'van Tilborgh|A J W|AJW|', 'de Vooght|K M K|KMK|', 'Bokhorst|A G|AG|', 'Wiersum-Osselton|J C|JC|http://orcid.org/0000-0003-3451-9911']
D058731:Blood Safety D001803:Blood Transfusion D003365:Costs and Cost Analysis D005104:Expert Testimony D006801:Humans D009426:Netherlands D065227:Transfusion Reaction
direct costs transfusion reactions expert judgement