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Making the blood supply safe also makes it more expensive

Nonprofit agencies that collect donations charge fees to cover their costs, which include testing.

September 02, 2007|Mary Engel | Times Staff Writer

Thanks to an array of tests for HIV, Chagas disease and other conditions, the current blood supply is "extremely safe," said Brick Bunch, laboratory manager at Downey Regional Medical Center.

It is also extremely expensive.

From 1979 to 2000, the average price that hospitals nationwide paid for a unit of red blood cells grew from $32 to $96, an increase of about 5% a year.

By 2004, the most recent year tallied in the U.S. government's biannual survey, the price had more than doubled to $201 per unit, which is roughly one pint.

The Downey medical center uses close to 500 units of red blood cells a month in addition to plasma and platelets.

"When I first got here in 2001, blood products cost between $800,000 and $950,000 annually," Bunch said. "We now have basically the same utilization -- a little bit of an increase -- and the cost is $2.3 million.

"That's just for blood product, not the work that goes into transfusing."

When blood is donated, it is separated into components -- red blood cells, platelets and plasma -- that have different uses.

Iron-rich red blood cells, for example, are used to treat congestive heart failure patients with anemia or trauma patients with acute blood loss.

Platelets, on the other hand, help with clotting. Platelets derived by apheresis, a technique that collects just one component of the blood and returns the rest to the donor, cost $425 a unit in 2002, Bunch said. Today, that cost is $520.

What's more, the new tests for platelets take so much time that they decrease the shelf life.

Though refrigerated red blood cells are good for 42 days, platelets require room-temperature storage and now must be used within 48 hours, down from five to seven days, Bunch said. Anything unused after that becomes a costly write-off.

Two organizations, the Red Cross and America's Blood Centers, a consortium of independent blood banks, collect and distribute more than 90% of the nation's blood supply. (Some hospitals have their own blood banks.)

As nonprofit entities, they don't "sell" blood; they charge hospitals fees to recover the costs of recruiting and screening donors and testing, processing, storing and delivering blood.

Why is something that is donated by volunteers and collected by nonprofit groups so costly?

Before 1985, when the AIDS epidemic prompted the addition of a test for HIV, blood was tested for type (A, B, AB or O), Rh factor (positive or negative) and syphilis.

Today the U.S. Food and Drug Administration requires 10 more tests.

One of the most recent -- and expensive -- additions is a test that can identify HIV genetically. (The older test screened blood for HIV antibodies, which can take months to develop, leaving open a window in which infected blood could go undetected.)

The risk of getting HIV from a blood transfusion is now about 1 in 2 million, according to the Red Cross.

Regional blood banks sometimes add tests or procedures not yet required by the FDA. Because of Southern California's large immigrant population, the Red Cross, for example, tests for the parasite that causes Chagas disease, which is widespread in Latin America.

The test adds $5 to $7 per unit. The local Red Cross also performs a process called leukocyte reduction to filter out white blood cells that can cause fever or other host immune reactions.

This adds as much as $30 for each unit of blood.

Across the country, blood prices vary by region. Lower rent for blood collection centers, laboratories and storage facilities and lower wages for administrators, nurses and technicians make blood donated in the middle of the country a bargain compared with blood on either coast.

A unit of red blood cells cost hospitals, on average, $168 in the Southeast United States compared with $203 in the Pacific region (which includes California) in 2005, according to America's Blood Centers.

Savings from lower rent and wages can be used to recruit new donors and promote blood drives, which, at least in part, explains why Southern and Midwestern states are able to collect enough blood to fill local needs and export the rest to Los Angeles, New York and other urban areas. The cost also varies, to some degree, by hospital.

To ensure a reliable long-term source of blood, hospitals usually contract with either the Red Cross or an America's Blood Centers supplier. When contracts come up for renewal, the bigger hospitals and chains press for bulk discounts.

Hospitals complain that Medicare, Medicaid and private insurance companies pay a set price for operations rather than reimbursing the full cost of blood.

"We can give a patient 20 units of blood, and we get paid for one," Bunch said. The rest, he added, is written off as a loss.

Patients and employers who pay rising insurance premiums complain that hospitals pass on the costs by padding the bill for a room or a surgeon, driving up medical costs overall.

Blood experts often ask themselves whether the pendulum has swung too far toward infinitesimal gains at exponential costs.

"We're certainly beyond the usual threshold of medical cost effectiveness," said Dr. Mike Busch, director of the Blood Systems Research Institute in San Francisco. "But if you need blood, you need blood. It falls in the rubric of airplane safety. You have to maintain the trust of the public in the system."

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