The impact of Daratumumab on transfusion service costs

• Published in: Transfusion (Philadelphia, Pa.) Vol. 59; no. 4; pp. 1252 - 1258
• Main Authors: Cushing, Melissa M., DeSimone, Robert A., Goel, Ruchika, Hsu, Yen‐Michael S., Parra, Priscilla, Racine‐Brzostek, Sabrina E., Degtyaryova, Diana, Lo, Dian T., Morrison, Meta, Crowley, Kathleen M., Rossi, Adrianna, Vasovic, Ljiljana V.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.04.2019; Wiley Subscription Services, Inc
• Subjects: Algorithms; CD38 antigen; Computer simulation; Costs and Cost Analysis; Denaturation; Dithiothreitol; Dithiothreitol - administration & dosage; Dithiothreitol - economics; Erythrocyte Transfusion - economics; Female; Genotyping; Health care facilities; Humans; Immunotherapy; Interference; Male; Monoclonal antibodies; Multiple myeloma; Multiple Myeloma - economics; Multiple Myeloma - therapy; Patients; Reagents; Targeted cancer therapy; Transfusion
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/trf.15134

BACKGROUND Daratumumab (DARA) is a human IgG1κ monoclonal antibody directed against CD38, approved for the treatment of multiple myeloma. As CD38 is expressed on RBCs, DARA can interfere with pretransfusion testing. DARA interference can be negated by denaturation of CD38 on RBCs with dithiothreitol (DTT) reagents. Because of this interference in pretransfusion testing, our hospital implemented a notification and testing/transfusion algorithm (NATTA) for pretransfusion testing and RBC product provision for DARA patients. This standardized approach combines DTT‐based testing with selective genotyping and the provision of phenotypically similar RBCs for patients with clinically significant antibodies. STUDY DESIGN AND METHODS We evaluated pretransfusion test results and transfusion requirements for 91 DARA patients in an academic medical center over 1 year to determine the incremental cost of pretransfusion testing and RBC selection. The actual costs for the NATTA approach were compared to a theoretical approach using universal genotyping with a provision of phenotypically similar RBC transfusions. RESULTS The annual cost of testing related to DARA after NATTA implementation was $535.76 per patient. The simulated annual cost for the alternative genotyping with provision of phenotypically similar RBC transfusions approach was $934.83 per patient. CONCLUSION In our entire cohort of DARA patients, a DTT‐based testing algorithm with selective genotyping and provision of phenotypically similar RBCs only for patients with clinically significant antibodies was less expensive than a simulated model of universal genotyping and provision of phenotypically similar RBCs.