U.S. Blood-Collection System Faces Multiple Threats, Study Finds

Authors call for increased government oversight

Medical advances have reduced the demand for blood in the United States, creating financial pressure on the nation’s blood-collection centers and threatening their future survival, according to a new Rand Corporation study.

While the existing system continues to function well, more government oversight of the nation’s blood system may be needed to safeguard the future of the blood supply and to prevent blood shortages from posing a risk to the public’s health, according to the report.

“The U.S. blood system operates effectively, but it is in a state of flux and uncertainty,” said lead author Andrew Mulcahy. “Financial pressures, changes in health care 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. We need a better, more-efficient, and more-sustainable system.”

The U.S. blood system collects, tests, processes, and distributes the blood that is ultimately used in clinical practice. In 2013, more than 14 million units of blood were collected in the U.S. from approximately 15.2 million individuals, with 13.2 million units transfused.

The Rand report finds that changes, such as less-invasive surgeries and new drugs, have lowered the demand for blood during the past decade, while the blood collection and distribution system has been downsized only slightly. At the same time, consolidation of hospital ownership has shifted negotiation power toward hospital buyers and away from blood centers.

The result has been increased competition among blood centers that has led to falling prices for blood, which slices into the centers’ already thin margins and revenue.

Meanwhile, technological innovation and the emergence of pathogens, such as the Zika virus, are adding new production and testing costs for blood suppliers. A dwindling pool of active donors poses another challenge.

In the short term, unexpected and sudden changes, such as the closure of multiple blood centers, could potentially affect the timely availability of safe blood products and could have other negative consequences, according to the researchers. In the long term, however, consolidation among blood centers may be necessary and may result in a stronger blood system.

The authors conclude that the best option for fortifying the U.S. blood system would be for the federal government to play a role in ensuring the system’s sustainability, rather than continuing the status quo or having the government assume operation of the blood system, as is done in some nations.

Fundamental to strengthening the blood system is for federal officials to begin collecting comprehensive data about the system’s performance, including details about blood use and financial arrangements between blood centers and hospitals.

The researchers also recommend that regulators better define appropriate levels of surge capacity to respond to public health emergencies and subsidize the ability of blood centers to maintain that capacity. They also urge government agencies to build relationships with other participants in the blood system to form a blood “safety net.”

In addition, the authors recommend the development of a value framework for new technologies to provide information about costs and benefits, and to guide decisions about adoption. And where technologies do not justify investments from a business perspective—yet have clear public health and preparedness benefits—policy-makers may want to require adoption and pay directly for those investments. The researchers also recommend the implementation of emergency-use authorization and contingency planning for key supplies and inputs.

Support for the study was provided by the Department of Health and Human Services.

Sources: Rand Corporation; November 28, 2016; and Rand Report; November 28, 2016.