Introducing Pathogen Reduction Technology in Poland: A Cost-Utility Analysis

Abstract

Background: Mirasol® pathogen reduction technology (PRT) uses UV light and riboflavin to chemically inactivate pathogens and white blood cells in blood components. In the EU, Mirasol PRT is CE-marked for both plasma and platelet treatment. In Poland, the decision to introduce PRT treatment of the national supply of fresh frozen plasma has spurred interest in evaluating the cost-effectiveness of this strategy.

Methods: A decision-analytic model evaluated the incremental costs and benefits of introducing PRT to the existing blood safety protocols in Poland.

Results: Addition of PRT treatment of plasma to current screening in Poland is estimated to cost 2.595 million PLN per quality-adjusted life year (QALY) (610,000 EUR/QALY); treating both plasma and platelet components in addition to current safety interventions had a lower cost of 1.480 million PLN/QALY (348,000 EUR/QALY).

Conclusions: The results suggest that in Poland the cost per QALY of PRT is high albeit lower than found in previous economic analyses of PRT and nucleic acid testing in North America. Treating both platelets and plasma components is more cost-effective than treating plasma alone. Wide confidence intervals indicate high uncertainty; to improve the precision of the health economic evaluation of PRT, additional hemovigilance data are needed.

Keywords: Blood safety; Cost-effectiveness; ICER; Mirasol PRT; Pathogen reduction technology; Poland.

Fig. 1

Tornado diagrams ranking the top most influential variables by providing the ICER ranges associated with each variables' estimated upper and lower bounds. a provides the most influential variables in the comparison of P-PRT to current screens and b provides the most influential variables in the comparison of PP-PRT to P-PRT. The legend for each plot provides the description of the variable, followed by the point estimate and the range used in one-way sensitivity analysis in brackets. The variable value producing the lower ICER result (left edge of each horizontal bar) is written first and the higher ICER is presented second. QoL = Quality of life.

Fig. 2

One-way sensitivity analysis of the effect of residual risk of bacterial contamination in platelets on the ICER results. As the baseline risk of bacterial risk increases from 1/50,000 (to the residual risk level modeled in plasma) to 1/3,333, the ICER of strategies including PRT treatment of platelets decreases dramatically when comparing PP-PRT to current screens (grey dashed line):from roughly 6.5 million PLN/QALY to 0.6 million PLN/QALY; and slightly when PP-PRT is compared to P-PRT (dark grey solid line): from 3.4 million PLN/QALY to 1.2 million PLN/QALY.

Fig. 3

Cost-effectiveness acceptability curves. In order to plot the results of the simulation using a cost-effectiveness acceptability curve, a range of willingness to pay values (on a cost per QALY basis) has to be defined. Across a range of values from 1.0-3.7 million PLN/QALY the curves shown indicate the probability that each strategy is cost-effective relative to the current screens comparison strategy.