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NIHR Signal New strategies for maintaining blood supplies from donations may be cost-effective

Published on 12 February 2019

doi: 10.3310/signal-000731

Opening blood donation centres on weekday evenings and at weekends is a cost-effective way of increasing the blood supply used by hospitals in the UK. Allowing donors to give blood more often could increase supplies in the short term, but it isn’t clear if it would be cost-effective in the long-term.

This NIHR-funded modelling study used data from a recent large randomised trial in the UK that investigated the safety of donating blood more frequently than current guidance allows. This was combined with current UK donation records, cost data, and the preferences of about 34,000 existing donors who were surveyed for this study. 

The NHS Blood and Transplant service is looking for ways to increase supplies of blood types that are in high demand. This study adds to the evidence about which strategies are both clinically effective and cost-effective. This should help to inform future service changes.

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Why was this study needed?

The NHS Blood and Transplant (NHSBT) service issued around 1.6 million units of red blood cells in 2015-16. While overall demand for blood has decreased in recent years, there is increasing demand for particular blood types. For example, the universal blood type (O negative) makes up about 13% of all hospital requests, but only around 7% of existing donors are blood type O negative.  Finding and retaining donors is expensive. So the NHSBT service needs to find alternative ways to ensure sufficient donations of high-demand blood types.  Encouraging existing donors to give blood more often might be one way of doing this.

This study aimed to identify cost-effective strategies for maintaining the blood supply.

What did this study do?

This health economics modelling study was made up of three parts:

  • A cost-effectiveness analysis of different minimum periods between donations, using data from the recent INTERVAL trial (a randomised trial of 45,263 whole-blood donors). The analysis used information on the number of donations, deferrals (temporary suspension from donating), and quality of life over two years.
  • Surveys of 25,187 participants from the INTERVAL trial and 9,318 other donors on donor preferences, including travel time, opening hours for appointments, and frequency of donations.
  • A cost-effectiveness analysis of alternative strategies, using data from the surveys and existing donor databases as well as evidence from the INTERVAL trial.

Cost-effectiveness was measured over one year, so longer-term effects were not considered.

What did it find?

  • In the INTERVAL trial, shorter intervals between donations increased the average number of whole-blood donations over two years. For men, the average number of donations increased by 1.71 (95% confidence interval [CI] 1.60 to 1.80) for the 8 vs 12-week interval arm of the trial, and by 0.79 (95% CI 0.70 to 0.88) for the 10 vs 12-week interval arm. For women, the increase was 0.85 (95% CI 0.78 to 0.92) for the 12 vs 16-week interval arm.
  • This increase in the average number of donations came at a small additional average cost compared with current practice. For example, the incremental cost-effectiveness ratio (ICER) was £9.51 for each donation/unit (95% CI £9.33 to £9.69) for men in the 8 vs 12-week interval arm of the trial. For women in the 12 vs 16-week interval arm, the ICER was £10.17 (95% CI £9.80 to £10.54).
  • The INTERVAL trial showed that shorter minimum donation intervals led to higher rates of deferral due to low haemoglobin levels. For men, the deferral rate was 5.7% per session in the 8-week interval arm, compared with 2.6% in the 12-week interval arm. For women, the rate was 7.9% in the 12-week interval and 5.1% in the 16-week interval.
  • The survey found that, for static donor centres (rather than mobile centres set up at specified times), making appointments available on weekday evenings and at weekends would increase the average frequency of donations per person by 0.5 per year.
  • The cost-effectiveness analysis found that extending opening times at all static centres to weekday evenings would provide additional units of blood at a cost of £23 per additional unit of blood. Extending to weekends at all static centres had a cost of £29 per additional unit of blood

What does current guidance say on this issue?

The Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee produces guidelines for the blood transfusion services in the UK. The section on the care and selection of donors says that an interval of 16 weeks between donations of whole blood is reasonable, with a minimum interval of 12 weeks. It also says that women should not donate more than three times in any 12-month period, and men can donate up to four times.

This is interpreted as men being able to donate every 12 weeks, and women being able to donate every 16 weeks.

What are the implications?

Extending opening hours to evenings and weekends at static donation centres is a relatively cost-effective way of increasing the blood supply. This could be targeted at donors whose blood types are in high demand to get the most value for the service. Other strategies like making mobile units available at weekends and producing health reports for donors were not cost-effective.

Shortening the time between donations also appeared a cost-effective way of providing additional blood in the short term, but also increases the rates of deferrals. Increasing deferrals may lead to people stopping donations altogether, which could bring higher costs that weren’t considered in this study and may not be cost-effective in the long term.

Citation and Funding

Grieve R, Willis S, De Corte K et al. Options for possible changes to the blood donation service: health economics modelling. Health Serv Deliv Res. 2018;6(40).

This project was funded by the Health Services and Delivery research programme of the National Institute for Health Research (project number 13/54/62).

Bibliography

Di Angelantonio E, Thompson SG, Kaptoge S et al. Efficiency and safety of varying the frequency of whole blood donation (INTERVAL): a randomised trial of 45 000 donors. Lancet. 2017;390:2360-7.

JPAC. Guidelines for the blood transfusion services in the United Kingdom. London: Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee; 2013.

NHS Blood and Transplant. Who can give blood? Bristol: NHS Blood and Transplant; accessed January 2019.

Why was this study needed?

The NHS Blood and Transplant (NHSBT) service issued around 1.6 million units of red blood cells in 2015-16. While overall demand for blood has decreased in recent years, there is increasing demand for particular blood types. For example, the universal blood type (O negative) makes up about 13% of all hospital requests, but only around 7% of existing donors are blood type O negative.  Finding and retaining donors is expensive. So the NHSBT service needs to find alternative ways to ensure sufficient donations of high-demand blood types.  Encouraging existing donors to give blood more often might be one way of doing this.

This study aimed to identify cost-effective strategies for maintaining the blood supply.

What did this study do?

This health economics modelling study was made up of three parts:

  • A cost-effectiveness analysis of different minimum periods between donations, using data from the recent INTERVAL trial (a randomised trial of 45,263 whole-blood donors). The analysis used information on the number of donations, deferrals (temporary suspension from donating), and quality of life over two years.
  • Surveys of 25,187 participants from the INTERVAL trial and 9,318 other donors on donor preferences, including travel time, opening hours for appointments, and frequency of donations.
  • A cost-effectiveness analysis of alternative strategies, using data from the surveys and existing donor databases as well as evidence from the INTERVAL trial.

Cost-effectiveness was measured over one year, so longer-term effects were not considered.

What did it find?

  • In the INTERVAL trial, shorter intervals between donations increased the average number of whole-blood donations over two years. For men, the average number of donations increased by 1.71 (95% confidence interval [CI] 1.60 to 1.80) for the 8 vs 12-week interval arm of the trial, and by 0.79 (95% CI 0.70 to 0.88) for the 10 vs 12-week interval arm. For women, the increase was 0.85 (95% CI 0.78 to 0.92) for the 12 vs 16-week interval arm.
  • This increase in the average number of donations came at a small additional average cost compared with current practice. For example, the incremental cost-effectiveness ratio (ICER) was £9.51 for each donation/unit (95% CI £9.33 to £9.69) for men in the 8 vs 12-week interval arm of the trial. For women in the 12 vs 16-week interval arm, the ICER was £10.17 (95% CI £9.80 to £10.54).
  • The INTERVAL trial showed that shorter minimum donation intervals led to higher rates of deferral due to low haemoglobin levels. For men, the deferral rate was 5.7% per session in the 8-week interval arm, compared with 2.6% in the 12-week interval arm. For women, the rate was 7.9% in the 12-week interval and 5.1% in the 16-week interval.
  • The survey found that, for static donor centres (rather than mobile centres set up at specified times), making appointments available on weekday evenings and at weekends would increase the average frequency of donations per person by 0.5 per year.
  • The cost-effectiveness analysis found that extending opening times at all static centres to weekday evenings would provide additional units of blood at a cost of £23 per additional unit of blood. Extending to weekends at all static centres had a cost of £29 per additional unit of blood

What does current guidance say on this issue?

The Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee produces guidelines for the blood transfusion services in the UK. The section on the care and selection of donors says that an interval of 16 weeks between donations of whole blood is reasonable, with a minimum interval of 12 weeks. It also says that women should not donate more than three times in any 12-month period, and men can donate up to four times.

This is interpreted as men being able to donate every 12 weeks, and women being able to donate every 16 weeks.

What are the implications?

Extending opening hours to evenings and weekends at static donation centres is a relatively cost-effective way of increasing the blood supply. This could be targeted at donors whose blood types are in high demand to get the most value for the service. Other strategies like making mobile units available at weekends and producing health reports for donors were not cost-effective.

Shortening the time between donations also appeared a cost-effective way of providing additional blood in the short term, but also increases the rates of deferrals. Increasing deferrals may lead to people stopping donations altogether, which could bring higher costs that weren’t considered in this study and may not be cost-effective in the long term.

Citation and Funding

Grieve R, Willis S, De Corte K et al. Options for possible changes to the blood donation service: health economics modelling. Health Serv Deliv Res. 2018;6(40).

This project was funded by the Health Services and Delivery research programme of the National Institute for Health Research (project number 13/54/62).

Bibliography

Di Angelantonio E, Thompson SG, Kaptoge S et al. Efficiency and safety of varying the frequency of whole blood donation (INTERVAL): a randomised trial of 45 000 donors. Lancet. 2017;390:2360-7.

JPAC. Guidelines for the blood transfusion services in the United Kingdom. London: Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee; 2013.

NHS Blood and Transplant. Who can give blood? Bristol: NHS Blood and Transplant; accessed January 2019.

Options for possible changes to the blood donation service: health economics modelling

Published on 14 December 2018

Grieve R, Willis S, De Corte K, Sadique M Z, Hawkins N, Perra S, Pennington M, Turner J, Moore C, Wickenden C, Koppitz C, Cho G, Roberts D J, Miflin G & Cairns J A.

Health Services and Delivery Research Volume 6 Issue 40 , 2018

Background Evidence is required on the cost-effectiveness of alternative changes to the blood collection service. Objectives (1) To estimate the cost-effectiveness of alternative minimum interdonation intervals between whole-blood donations. (2) To investigate donors’ frequency of whole-blood donation according to alternative changes to the blood collection service. (3) To estimate the cost-effectiveness of alternative strategies for maintaining the supply of whole blood. Methods We undertook a within-trial cost-effectiveness analysis (CEA) of the INTERVAL trial, stated preference (SP) surveys to elicit donor preferences and a CEA of different strategies for blood collection. The strategies considered were reduced minimum intervals between whole-blood donations, introduction of a donor health report and changes to appointment availability and opening times at blood collection venues. The within-trial CEA included 44,863 donors, with men randomly assigned to 12- versus 10- versus 8-week interdonation intervals, and women to 16- versus 14- versus 12-week interdonation intervals. We undertook a SP survey of non-INTERVAL donors (100,000 invitees). We asked donors to state the frequency with which they would be willing to donate blood, according to the service attribute and level. The CEA compared changes to the blood service with current practice by combining the survey estimates with information from the NHS Blood and Transpant database (PULSE) and cost data. The target population was existing whole-blood donors in England, of whom approximately 85% currently donate whole blood at mobile (temporary) blood collection venues, with the remainder donating at static (permanent) blood collection centres. We reported the effects of the alternative strategies on the number of whole-blood donations, costs and cost-effectiveness. Results The reduced donation interval strategies had higher deferral rates caused by low haemoglobin (Hb), but increased frequency of successful donation. For men in the 8- versus 12-week arm of the INTERVAL trial [Di Angelantonio E, Thompson SG, Kaptoge S, Moore C, Walker M, Armitage J, et al. Efficiency and safety of varying the frequency of whole blood donation (INTERVAL): a randomised trial of 45 000 donors. Lancet 2017;390:2360–71], the Hb-related deferral rate was 5.7% per session versus 2.6% per session, but the average number of donations over 2 years increased by 1.71 (95% confidence interval 1.60 to 1.80). A total of 25,187 (25%) donors responded to the SP survey. For static donor centres, extending appointment availability to weekday evenings or weekends, or reduced intervals between blood donations, increased stated donation frequency by, on average, 0.5 donations per year. The CEA found that reducing the minimum interval, extending opening times to weekday evenings and extending opening times to weekends in all static donor centres would provide additional whole blood at a cost per additional unit of £10, £23 and £29, respectively, with similar results for donors with high-demand blood types. Limitations The study did not consider the long-term rates at which donors will leave the donation register, for example following higher rates of Hb-related deferral. Conclusions Extending opening hours for blood donation to weekday evenings or weekends for all static donor centres are cost-effective ways of increasing the supply of high-demand blood types. Future work To monitor the effects of new strategies on long-term donation frequency. Funding The National Institute for Health Research Health Services and Delivery Research programme.

Expert commentary

Despite the falling demand for blood in hospitals, collection of sufficient blood from volunteer donors is challenging for blood services worldwide. The minimum interval between donations varies from country to country.

One of the findings of this study was, not surprisingly, that shortening the interval between donations increases the number of donations. However, it is at the cost of increasing the number of donor deferrals because of a low haemoglobin concentration, most likely to be due to depletion of iron stores.

One of the implications of this study is the need for blood services to consider implementing measures to reduce donor deferral due to low haemoglobin. Such measures include ferritin testing to monitor iron stores and/or administration of iron to restore iron stores.

Mike Murphy, Professor of Blood Transfusion Medicine, University of Oxford; Consultant Haematologist, NHS Blood & Transplant & Oxford University Hospitals NHS Foundation Trust

The commentator declares no conflicting interests