Less-invasive surgeries and new drugs have stanched demand, but more government oversight is needed to safeguard the supply of blood to hospitals.
The nation's blood collection system may require more rigorous government oversight to protect the blood supply from shortages and health risks, a new RAND Corporation study says.
"The U.S. blood system operates effectively, but it is in a state of flux and uncertainty," Andrew Mulcahy, lead author of the study and a policy researcher at RAND, said in comments accompanying the study.
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"Financial pressures, changes in healthcare practice and technology, and the emergence of external threats such as the Zika virus are pressuring the system and may potentially threaten the available supply of blood," Mulcahy said. "We need a better, more-efficient and more-sustainable system."
Medical advances such as less-invasive surgeries and new drugs have decreased the demand for blood during the past decade. However, the size of the blood collection and distribution system has decreased only slightly, according to the RAND study.
At the same time, hospital consolidation has given larger hospitals a leg up in negotiating for lower blood prices. The result has been increased competition among blood centers that has led to falling prices for blood, which slices into blood centers' already thin margins and revenue.
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In addition, blood suppliers are grappling with technological innovations and the emergence of pathogens, such as the Zika virus, which add new production and testing costs. A dwindling pool of active donors poses an additional challenge.
To address these issues, the RAND study recommends:
- Collecting data on blood use and financial arrangements: Stakeholders have access to statistics on blood use and transactions tied to their individual organizations, but the U.S. government does not have access to comprehensive data describing the performance of the blood system.
- Developing a vision for appropriate levels of surge capacity: Describing a desired level of surge capacity from a public health and preparedness perspective will help stakeholders and policymakers plan and estimate the costs associated with maintaining surge capacity.
- Subsidizing blood centers' ability to maintain surge capacity: Surge capacity to respond to serious events and emergencies falls outside the typical financial arrangements between hospitals and blood centers, so there is an argument that the government should separately finance this surge capacity.
- Building relationships with brokers and other entities to form a blood "safety net": A well-established set of relationships can reduce emergency response times.
- Building a value framework for new technology: We recommend that HHS invest in health technology assessment research for existing technologies with low adoption rates and for technologies on the horizon.
- Paying directly for new technologies in which there is no private business case for adoption: Technologies often have clear public health and preparedness benefits. In these cases, U.S. government financing of technology acquisition costs might be appropriate.
- Implementing emergency use authorization and contingency planning for key supplies and inputs: The FDA could implement emergency use authorizations for replacement supplies and other inputs in the event of a shortage.
Mulcahy said in the long term the blood supply market may need to consolidate. In the shorter term, however, the abrupt closure of multiple blood centers owing to these market pressure could affect the availability of safe blood products.