Transcript Win-Win solutions

Why "We" should Care
Presented to:
International Blood Safety Forum
Jed Gorlin MD, MBA
March 20, 2015
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Win-Win solutions
• Advantages for
industry
– Growing markets
• Advantages for 1st
world blood programs
– Motivating Staff
S/D
Increase
Factors
Decrease
Demand
Aging population
Aggressive Cancer therapy for
older patients
Increased insurance coverage
Cord blood vs PBSC Transplant
Other cell Rx
Pathogen Rx (if product loss
during manufacture)
Broader use of anticoagulants
High deductible health plans
decrease elective procedures
Blood management (fewer units
per transfusion, lower Tx triggers
Clinical trials
Blood substitutes
? Trends towards smaller family
size (decreased childbirth)
Supply
16 yo donors, tattoo licensing
Double RBC
ABO inventory issues
More rationale malaria
deferrals/test
Blood center importers
increasing collections to achieve
independence
Aging population
Increase in Hgb eligibility, deferral
period (to protect donor Iron)
Trials showing older blood is
“bad”
Additional required tests
(Babesia, Dengue, Chikungunya)
or travel deferrals
Innovative Blood Resources
RBC Local Usage FY2010 – FY2014
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Advantages for industry
• US RBC market is shrinking 2-5%/year (and
decline shows little sign of leveling off)
– Usage was >50 RBC units/1000 population
• Now below 45 but Canada is in mid 30’s
• Group purchasing and health care systems formally
adopting blood management programs
• Choosing Wisely encouraging lower RBC
use/transfusion volume (1 vs. 2 units)
• Accountable care intended to make all hospital
spending a cost center, not a revenue driver
Emerging markets
• Want adequate
supplies
– Help in collecting
enough blood
– Access to
economical quality
blood collection
equipment
– Access to quality
systems
• Software
supportable by
local staff and able
to run on simple IT
systems
• Want safe blood
– Western model of >$1 million/QUALY not
sustainable
– But: Is pathogen inactivation cheaper
than broad scale screening?
– Pre-donation rapid tests can add a layer of
safety but not adequate alone
Rwanda Blood Transfusion
CNTS collects 38,000 volunteer units fully tested for HIV, Hepatitis B & C
Afghanistan Maternity Hospital
(Rabia Balkhi) transfusion service
ABO/Rh typing but no Antibody screen
Whole blood is collected from family
Replacement donors
Malalai maternity hospital
• Malalai hospital had exactly
one O negative unit and only
3 O+ units on the shelf. They
have over 120 deliveries
daily!
Market opportunities
• Honduras Red Cross
• Dr. Elizabeth Vinelli
– CEO received donation
of older model
Hemocue devices but
couldn’t obtain cuvettes
in local market
– I contacted HemoCue
North America to
facilitate access to
needed supplies
Market opportunities: Kazakhstan
• National blood program has access to
•
•
•
•
NAT testing
Pathogen inactivation
Blood irradiation
Automated collections
AIHA Central Asia Project
• Kazakhstan is
almost as large as
US but has 18
million people
– GDP/capita ~12K
• Kyrgyzstan has ~6
million people
– GDP/capita ~1K
• US has ~350 million
people and
GDP/capita ~58K
AABB poster 132
• A Voluntary non-remunerated blood program in the
Kyrgyz republic
– Over the last 20 years, the # of active blood donors in
Kyrgyzstan has declined almost 6 fold from Soviet times
with current rate ~5/1,000 pop.
– Majority of current donors are family/replacement donors
– Program aims to increase VNRD from 23 to 50% by 2018
and reduce TTI discards from 18% to 10 % .
• 2013 results: 34 K donations
– 75% FRD, 23% VNRD, 2% paid
– Increase to ~6/1,000
Kyrgyz Prikaz (Order)
AIHA Goal:
Work with local
Kyrgyz
Staff to update Prikaz
This is the main order
that sets all rules and
requirements for
blood transfusion
Dr. Chursin, director
of Anesthesia at the
largest hospital in
Almaty had done
similar work in
Kazakhstan
KYR Blood donor center collections
Blood typing and hemoglobin screening
Donor testing tubes- no vacutainers were
available, so diversion pouches were not used
KYRGYZSTAN:Whole blood platelets are
made upon order for a specific patient
Market Opportunity: China
• Active competition
to provide
technology for:
– Automated
collections
• Apheresis platelets,
double red cells
– Advanced testing
• NAT testing
• Pathogen inactivation
Qingdao blood center
Motivation for staff