Blood Product Supply in Germany: The Impact of Apheresis and Pooled Platelet Concentrates

Abstract

Background: In Germany, about 60% of all produced platelet concentrates (PCs) are apheresis PCs (APCs). Ongoing discussions on APC reimbursement and costs might lead to a potential shift in pooled PC (PPC)/APC production. Objective of this analysis was to build a comprehensive model from the societal perspective to evaluate consequences associated with shifts in platelet supply and demand.

Methods: Literature search, desktop researches on platelet supply and demand. Model calculations, time horizon one year: model input from the Paul-Ehrlich-Institute, data 2013. Base case: 19.2% of annual whole blood donations (WBDs) were used for production of 38.5% PPCs, decay of 46,218 PCs (8.0%). Scenarios calculated: variation in PPC proportion of 10-100%.

Results: Base case: during PPC production 41,957-83,913 red blood cell concentrates (RBCCs) are estimated to be lost, which corresponds to 1-2% of annual RBCCs in Germany. Scenarios were calculated for a production of 60-100% PPCs: loss is estimated to be 1.5-5.0% of annual RBCCs (65,430-218,099), decay 54,189-69,022 PCs (9.4-12.0%).

Conclusion: Production of different blood components is interlinked and sensitive to unidimensional decisions. Increasing PPC proportion has negative impact on the RBCC production and on the antigen-matched APC donor pool. Completion of the model calculations to predict the optimal PPC/APC proportion would require evidence on the number of refractory patients, donor pool sizes, and incidences of diseases requiring platelet transfusions.

Keywords: Antigen-matched platelets; Apheresis platelets; Donor pool; Pooled platelets; Red blood cell concentrates.

Fig. 1

Model: influences on the proportion of PPCs and APCs required in the future. Reliable models of future PC supply and demand have to consider epidemiological data on PC demand, various aspects of PC production and the special demand of specific patients for single donor APCs. Aspects of future PC production are donor availability, WBDs and apheresis donations, losses of WBDs due to buffy coat production and subsequently RBCCs, the size of the donor pool needed to provide sufficient HLA/HPA-typed platelets for specific patients, and the decay of PCs at the producer. Aspects of the demand of specific patients for APCs are the epidemiology of alloimmunization and FNAIT, the demand in pediatrics, and possible advantages of single-donor APCs for hemato-oncological patients.