A 5-year cost analysis of automated red cell exchange transfusion for the management of recurrent painful crises in adult patients with sickle cell disease

The painful vaso-occlusive crisis is the most common acute manifestation of sickle cell disease resulting in poor quality of life and high utilisation of hospital facilities. The main disease modifying strategy is treatment with hydroxycarbamide. For patients intolerant or who fail hydroxycarbamide, chronic transfusions are an alternative. Automated red cell exchange transfusion (ARCET) are more effective in lowering rapidly the HbS level while avoiding iron overload. As they require specialised equipment and specially trained staff while utilising higher volumes of blood, there have been concerns regarding the costs involved. We retrospectively analysed data on 23 patients who have been on a regular programme for 1-5 years and found that their utilisation of hospital services reduced by 20%, 48%, 58%, 71%, and 79% after 1, 2, 3, 4 and 5 years respectively. The overall mean annual cost of care per patient was £9702 and £2378 higher than baseline after the 1st and 2nd years of ARCET respectively and then reduced by £5486, £8317, and £14,664 after the 3rd, 4th and 5th year of ARCET respectively indicating that ARCET leads to cost savings to health services in the medium to long term due to reduction in hospital attendance of these patients.