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Sadique Z, Willis S, Corte KD, Pennington M, Moore C, Kaptoge S, Angelantonio ED, Miflin G, Roberts DJ, Grieve R. Cost-effectiveness of alternative minimum recall intervals between whole blood donations. PLoS One 2022; 17:e0272854. [PMID: 35976959 PMCID: PMC9384981 DOI: 10.1371/journal.pone.0272854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 07/25/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The INTERVAL trial showed shorter inter-donation intervals could safely increase the frequency of whole-blood donation. We extended the INTERVAL trial to consider the relative cost-effectiveness of reduced inter-donation intervals. METHODS Our within-trial cost-effectiveness analysis (CEA) used data from 44,863 whole-blood donors randomly assigned to 12, 10 or 8 week (males), and 16, 14 or 12 week inter-donation intervals (females). The CEA analysed the number of whole-blood donations, deferrals including low- haemoglobin deferrals, and donors' health-related quality of life (QoL) to report costs and cost-effectiveness over two years. FINDINGS The mean number of blood donation visits over two years was higher for the reduced interval strategies, for males (7.76, 6.60 and 5.68 average donations in the 8-, 10- and 12- week arms) and for females (5.10, 4.60 and 4.01 donations in the 12-, 14- and 16- week arms). For males, the average rate of deferral for low haemoglobin per session attended, was 5.71% (8- week arm), 3.73% (10- week), and 2.55% (12- week), and for females the rates were: 7.92% (12-week), 6.63% (14- week), and 5.05% (16- week). Donors' QoL was similar across strategies, although self-reported symptoms were increased with shorter donation intervals. The shorter interval strategies increased average cost, with incremental cost-effectiveness ratios of £9.51 (95% CI 9.33 to 9.69) per additional whole-blood donation for the 8- versus 12- week interval for males, and £10.17 (95% CI 9.80 to 10.54) for the 12- versus 16- week interval arm for females. CONCLUSIONS Over two years, reducing the minimum donation interval could provide additional units of whole-blood at a small additional cost, including for those donor subgroups whose blood type is in relatively high demand. However, the significance of self-reported symptoms needs to be investigated further before these policies are expanded.
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Affiliation(s)
- Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Sarah Willis
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kaat De Corte
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark Pennington
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Health Services and Population Research, King’s College London, London, United Kingdom
| | - Carmel Moore
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
- University of East Anglia, Norwich, United Kingdom
| | - Stephen Kaptoge
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Emanuele Di Angelantonio
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Gail Miflin
- NHS Blood and Transplant, Liverpool, United Kingdom
| | - David J. Roberts
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
- NHS Blood and Transplant, Liverpool, United Kingdom
- Radcliffe Department of Medicine and BRC Biomedical Centre–Haematology Theme, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Richard Grieve
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Grieve R, Willis S, De Corte K, Sadique MZ, Hawkins N, Perra S, Pennington M, Turner J, Moore C, Wickenden C, Koppitz C, Cho G, Roberts DJ, Miflin G, Cairns JA. Options for possible changes to the blood donation service: health economics modelling. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundEvidence 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.MethodsWe 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.ResultsThe 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.Lancet2017;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.LimitationsThe 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.ConclusionsExtending 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 workTo monitor the effects of new strategies on long-term donation frequency.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Richard Grieve
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Willis
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kaat De Corte
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - M Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Neil Hawkins
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Silvia Perra
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Pennington
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Department of Health Services & Population Research, King’s College London, London, UK
| | - Jenny Turner
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Carmel Moore
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- INTERVAL Coordinating Centre, Department of Public Health and Primary Care, Cambridge, UK
| | | | | | - Gavin Cho
- NHS Blood and Transplant, London, UK
| | - David J Roberts
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- NHS Blood and Transplant, London, UK
- Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | | | - John A Cairns
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Willis S, De Corte K, Cairns JA, Zia Sadique M, Hawkins N, Pennington M, Cho G, Roberts DJ, Miflin G, Grieve R. Cost-effectiveness of alternative changes to a national blood collection service. Transfus Med 2018; 29 Suppl 1:42-51. [PMID: 29767450 PMCID: PMC7379655 DOI: 10.1111/tme.12537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/08/2018] [Accepted: 04/09/2018] [Indexed: 12/04/2022]
Abstract
Objectives To evaluate the cost‐effectiveness of changing opening times, introducing a donor health report and reducing the minimum inter‐donation interval for donors attending static centres. Background Evidence is required about the effect of changes to the blood collection service on costs and the frequency of donation. Methods/Materials This study estimated the effect of changes to the blood collection service in England on the annual number of whole‐blood donations by current donors. We used donors' responses to a stated preference survey, donor registry data on donation frequency and deferral rates from the INTERVAL trial. Costs measured were those anticipated to differ between strategies. We reported the cost per additional unit of blood collected for each strategy versus current practice. Strategies with a cost per additional unit of whole blood less than £30 (an estimate of the current cost of collection) were judged likely to be cost‐effective. Results In static donor centres, extending opening times to evenings and weekends provided an additional unit of whole blood at a cost of £23 and £29, respectively. Introducing a health report cost £130 per additional unit of blood collected. Although the strategy of reducing the minimum inter‐donation interval had the lowest cost per additional unit of blood collected (£10), this increased the rate of deferrals due to low haemoglobin (Hb). Conclusion The introduction of a donor health report is unlikely to provide a sufficient increase in donation frequency to justify the additional costs. A more cost‐effective change is to extend opening hours for blood collection at static centres.
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Affiliation(s)
- S Willis
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - K De Corte
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - J A Cairns
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - M Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - N Hawkins
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - M Pennington
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Department of Health Services and Population Research, King's College London, London, UK
| | - G Cho
- NHS Blood and Transplant, London, UK
| | - D J Roberts
- NHS Blood and Transplant, London, UK.,Radcliffe Department of Medicine and BRC Oxford Haematology Theme, University of Oxford, John Radcliffe Hospital, Oxford, UK.,NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - G Miflin
- NHS Blood and Transplant, London, UK
| | - R Grieve
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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How Can We Improve Retention of the First-Time Donor? A Systematic Review of the Current Evidence. Transfus Med Rev 2016; 30:81-91. [PMID: 26971186 DOI: 10.1016/j.tmrv.2016.02.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 02/15/2016] [Indexed: 11/22/2022]
Abstract
Blood products are critical to health systems and donations by voluntary nonremunerated donors are recommended. Worldwide, however, only around 5% of those eligible to donate do so and around half of those never return to donate again. This review focuses on what deters first-time donors, what predicts their retention, and what interventions may promote retention of this group. A comprehensive search of relevant databases identified 9 studies investigating motives and deterrents of first-time donors, 14 studies investigating predictors for first-time donors (13 whole blood [WB] and 2 plasmapheresis), and 15 studies (in 14 published articles) detailing interventions conducted on first-time donors. Drawing on an established blood donation taxonomy, studies were classified by 2 independent raters. Interventions were also classified into traditional, behavioral, or social science interventions. With only 2 eligible studies among first-time plasmapheresis donors, analyses focused on WB donors. First-time WB donors reported benevolent and collectivistic motivations, as well as personal benefits to commence WB donation. Self-reported deterrents have typically not been examined. Intention predicted first-time donor retention with intention determined by attitudes and a sense of (perceived behavioral) control. However, anxiety, adverse events, and deferrals all deterred retention. Traditional interventions, such as reminders and incentives, are widespread yet had only a small effect on return of first-time donors. Although behavioral science interventions such as fluid loading are effective, the strongest effect for the return of first-time donors was found when individual psychological support was provided. The purpose of this analysis was to identify the factors associated with the commencement and continuation of first WB donations. The current review revealed that self-reported motivators are typically not effective, and most successful predictive factors identified have not been translated into interventions. Future work would do well to identify, manage, and meet donors' expectations along with developing more individualized donation experiences. Blood donor research should delineate donor career stages; addressing first-time donor retention will support stable panels for blood collection agencies.
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Weidmann C, Schneider S, Litaker D, Weck E, Klüter H. A spatial regression analysis of German community characteristics associated with voluntary non-remunerated blood donor rates. Vox Sang 2011; 102:47-54. [PMID: 21534984 DOI: 10.1111/j.1423-0410.2011.01501.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Previous studies have shown substantial geographical variation in blood donation within developed countries. To understand this issue better, we identified community characteristics associated with blood donor rates in German municipalities in an ecological analysis. MATERIALS AND METHODS We calculated an aggregated rate of voluntary blood donors from each of 1533 municipalities in south-west Germany in 2007 from a database of the German Red Cross Blood Service. A multiple linear regression model estimated the association between the municipality-specific donor rate and several community characteristics. Finally, a spatial lag regression model was used to control for spatial autocorrelation that occurs when neighbouring units are related to each other. RESULTS The spatial lag regression model showed that a relatively larger population, a higher percentage of inhabitants older than 30 years, a higher percentage of non-German citizens and a higher percentage of unemployed persons were associated with lower municipality-specific donor rates. Conversely, a higher donor rate was correlated with higher voter turnout, a higher percentage of inhabitants between 18 and 24 years and more frequent mobile donation sites. CONCLUSIONS Blood donation appears to be a highly clustered regional phenomenon, suggesting the need for regionally targeted recruiting efforts and careful consideration of the value of mobile donation sites. Our model further suggests that municipalities with a decreasing percentage of 18- to 24-year-olds and an increasing percentage of older inhabitants may experience substantial declines in future blood donations.
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Affiliation(s)
- C Weidmann
- Mannheim Institute of Public Health, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
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Saberton PJ, Paez A, Newbold KB, Heddle NM. Geographical variations in the correlates of blood donor turnout rates: an investigation of Canadian metropolitan areas. Int J Health Geogr 2009; 8:56. [PMID: 19825154 PMCID: PMC2768701 DOI: 10.1186/1476-072x-8-56] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 10/13/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Like other countries, Canada's population is aging, and the implications of this demographic change need to be better understood from the perspective of blood supply. Analysis of donor data will help to identify systematic patterns of donation and its correlates. DATA Geo-coded blood donor and donor clinic data are provided by Canadian Blood Services. Blood donor data is provided for the fiscal year 2006-2007 indicating the total number of donors for each Canadian postal code, excluding the province of Québec. Potential correlates of blood donation are selected based on social and economic characteristics, as well as descriptors of city size and geographical location in the urban hierarchy measures of accessibility, and capacity of donor clinics. METHODS Data is aggregated to n = 3,746 census tracts in 40 Census Metropolitan Areas (CMA) across the country. The number of donors per population in a census tract is regressed against the set of potential donation correlates. Autocorrelation is tested for and results adjusted to provide parsimonious models. RESULTS A number of factors are found to influence donation across the country, including the proportion of younger residents, English ability, proportion of people with immigrant status, higher education, and a population-based measure of accessibility. CONCLUSION While a number of correlates of blood donation are observed across Canada, important contextual effects across metropolitan areas are highlighted. The paper concludes by looking at policy options that are aimed toward further understanding donor behaviour.
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Affiliation(s)
- P J Saberton
- School of Geography and Earth Sciences, McMaster University, Hamilton Ontario, Canada.
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