Costs Associated With Transfusion Therapy In Patients With Myelodysplastic Syndromes In Sweden: A Nationwide Retrospective Cohort Study

Background and objectives Blood transfusion is a cornerstone therapy for many patients with myelodysplastic syndromes (MDS), but ranges from few to no transfusions to intensive transfusion therapy. To date, no large studies have described transfusion use or costs for patients with MDS, accounting for the range of disease severity.Materials and methods A nationwide cohort study was conducted with all patients diagnosed with MDS in Sweden between 2008 and 2017, based on the Swedish MDS register and the Swedish part of the Scandinavian Donations and Transfusions Database 3 (SCANDAT3-S). Patients were followed from diagnosis until death, emigration, allogeneic hematopoietic stem cell transplantation or end of follow-up. Average cumulative transfusion count and costs over time were calculated, stratified by the revised international prognostic scoring system (IPSS-R) and age at diagnosis. Costs calculations used data on incident transfusions and laboratory testing and were divided into: direct material costs, direct labour costs and laboratory costs.Results In total, 2311 patients were included in the cohort. In the first four years after diagnosis, patients in the very low IPSS-R category received on average 25 red cell (95% confidence interval, 20-32) and 4 (3-7) platelet transfusions. Conversely, patients in the very high-risk category received on average 171 (135-200) red cell and 66 (51-78) platelet transfusions. Correspondingly, transfusion costs ranged from $8805 ($6482-$11 625) to $80 106 ($61 460-$95 792).Conclusion Transfusion count and costs for patients with MDS increased markedly with IPSS-R risk category, but were similar across age groups. Transfusion costs were considerable for the highest IPSS-R risk categories.