Red blood cell transfusions in the Netherlands Towards (very) low use

Transcription

1 Red blood cell transfusions in the Netherlands Towards (very) low use Marian G.J. van Kraaij, MD PhD hematologist/ transfusion medicine specialist Director Dept Transfusion Medicine Sanquin Blood Supply, The Netherlands May 30,

2 Outline 1. Blood supply organization in the Netherlands 2. Number of blood products transfused in the Netherlands (compared to other European countries) 3. Reasons for decline of transfused blood products Conclusions May 30,

3 1. Blood supply organization in the Netherlands Sanquin only Blood Supply Organisation in the Netherlands 1998 Sanquin Foundation 22 Blood Banks -> one National Blood Bank: Sanquin (goal: improve quality and uniformity) Dutch Blood Supply Act Voluntary non-remunerated donors Self-sufficient Controlled by Government (Ministry of Health, Welfare and Sports) evaluation every 3 years safety, quality, efficacy, and efficiency May 30,

4 red blood cells national hospitals and other healthcare institutes platelets fresh frozen plasma Sanquin Public sector Privat sector national and international organizations pharmaceuticals derived from plasma 3000 employees; 400,000 donors May 30,

5 Board of Directors Staff and Services Blood Bank Research Diagnostics Reagents Plasma products Pharmaceutical Services Sanquin s aim is an optimal blood supply, the only real purpose is the health of the patient. Transparent and clear communication is required to achieve this goal. Sanquin focuses its attention on the needs, questions and observations of doctors, hospitals, pharmacists, and professionals from other organisations. May 30,

6 2. Number of blood transfusions in the Netherlands RBC s: 490,000 Units Blood products (2012): 490,000 red blood cell units Platelets: 59,000 Units 59,000 platelet units 75,000 fresh frozen plasma FFP: 75,000 Units May 30,

7 Trend delivery of red blood cells Red Blood Cells : decrease of 14% since ,5 per 1000 inhabitants May 30,

8 Benchmark Europe Use of red blood cell units per 1,000 inhabitants (survey 2010) Red Blood Cell Units per 1,000 inhabitants Belgium France Denmark Germany Ireland Netherlands Spain United Kingdom Survey 2010 European Directorate for the Quality of Medicines and Health Care May 30,

9 3. (Possible) reasons for decreasing use of red blood cells in the Netherlands National guideline Blood Transfusion (2004, 2011 revised version) Quality Act for Health Care institutes and national hemovigilance office TRIP (Transfusion and Transplantation Reactions In Patients; founded 2001) Benchmark blood use between Dutch Hospitals/ Consultancy of Dept. of Transfusion Medicine Sanquin Blood Bank Reimbursement system for blood products in the Netherlands Cost reduction health care -> hospitals have to economize (6%) and quality indicators Dutch Society of Surgeons -> concentration of care May 30,

10 National Guideline Blood Transfusion Effective use of blood products so-called rule (depending on the presence of co-morbidity, the threshold for RBC transfusion varies between 4.0 mmol/l (6.4 g/dl) and 6.0 mmol/l (9,7 g/dl) alternatives for red blood cell transfusion pharmaceuticals, cell savers improvement of operation techniques Transfusion Guideline 2011, Dutch Institute for Health Care Improvement CBO May 30,

11 Quality Act for Health Care Institutes and National hemovigilance bureau TRIP Quality Act for Health Care Institutes each hospital should have a Blood Transfusion Committee including a Haemovigilance Officer and preferably a Hemovigilance Employee a representative of Sanquin Blood Supply quality, safety and efficacy indicators responsible for adequate transfusion chain TRIP (transfusion an transplantation reactions in patients 2001) transfusion reactions from 96% of Dutch Hospitals are reported to TRIP also errors in transfusion chain including unneccesary transfusions or avoidable wastage of a blood component May 30,

12 Benchmark Blood Use Dutch Hospitals Red blood cell use January - June 2012, Dutch University Hospitals May 30,

13 Consultancy Dept. of Transfusion Medicine Dept. of Transfusion Medicine of Sanquin Blood Bank transfusion physicians hematologists/ Pediatricians/ Internal Medicine specialist specialized in Transfusion Medicine who partly work in (University) hospitals Consultancy hospitals and transfusion laboratories (and everyone else) participant of Blood Transfusion Committees in hospitals special (not standard) blood products and products for research purposes transfusion reactions (hemovigilance) and post-marketing surveillance (stem)cell apheresis (advise and service) Education and Clinical Research efficacious use of blood products evidence based clinical research (together with Center of Clinical Transfusion Research Sanquin Research Division) May 30,

14 Reimbursement system blood products Ministry Dutch Health Authority Hospital 1 and 2: determine price of blood products 3 and 4: through Dutch Health Authority hospitals are reimbursed for costs of blood products (lump sum) 5 and 6: Sanquin delivers blood products and is paid by the hospital May 30,

15 Finance structure in hospitals lump sum Hospital Board Transfusion Laboratory Hospital Departments amount of money safed for the hospital May 30,

16 Future reimbursement system Grouper -> average costs of a certain treatment Disease- Treatment System From 2015 also blood products into the grouper May 30,

17 Cost reduction hospitals/ Quality indicators Need for cost reduction of hospitals indicated by Government (6%): decrease of 10% total number of treatments in 2012 Concentration of surgical care to increase quality (2012): decrease of operations, decrease of complications -> less blood use Red Blood Cells % decrease , of which 9% over May 30,

18 Conclusions Decrease of 14% of red blood cell use in period Several reasons for decrease guidelines and quality indicators consultancy dept. of Transfusion Medicine reimbursement system economical reasons However, we do not know whether less is better (besides for economical reasons) evidence from some clinical studies that less is better (methodology and patient selection) more evidence based clinical studies on red blood transfusion are needed need for more benchmark studies within Europe -> best practice May 30,

19 Questions? May 30,