Falling demand for blood is creating financial challenges and fueling uncertainty for organizations depended on to maintain the nation's blood supply, according to a new study sponsored by the federal government.
Changes in clinical practice and medical technology have lessened the need for transfusions from donated sources over the past decade. While such innovations have benefited patients and providers, it also has dampened the price paid for blood, according to Dr. Louis Katz, chief medical officer for America's Blood Centers, a network of community-based, independent blood banks that collects just more than half of the country's blood supply.
Katz said more than 60% of the blood collected in the U.S. is from centers operating at a negative net margin.
More than 14 million units of blood were collected in the United States from about 15.2 million individuals in 2013, according to the study released Monday by the Rand Corp., with 13.2 million units transfused.
Overall the study found the current U.S. blood system operates effectively and called the threat of a disruption to the blood supply “unlikely”.
But orders for blood have fallen among hospitals over the past decade due to an increase in less-invasive surgeries as well as mounting evidence that blood transfusions were being overused. Also, hospital consolidation has allowed providers to negotiate lower prices, according to the report.
At the same time the emergence of new public health dangers like Zika virus have added new costs for blood centers, which are required to test for the virus among new donors and within their current supplies.
“It's just kind of a perfect storm,” Katz said. “All those pressures come together and it's not sustainable.”
The Rand researchers recommended several ways the federal government could get involved to help ensure a reliable blood supply. They include defining capacity levels at which blood centers should maintain supplies to address public health emergencies; subsidizing blood centers for maintaining surge capacity during those events; and better monitoring on blood use to understand how much blood is used and stored in hospitals.
“A desire on the part of blood centers to improve their market position is not itself a rationale for policy action,” the study concluded. “However, if the pressures facing blood centers lead to unexpected or rapid changes in the supply of blood—for example, as a result of a wave of blood center closures—policy could help minimize the negative consequences from these changes.”
Katz said the decrease in demand for red blood cell products began in 1999 but accelerated in 2008. Sales are down nearly one-third from 50 units for every 1,000 people in 2008 to about 35 units for every 1,000 people in 2015.
Given the importance of sustaining the blood supply, Katz said it was time to reconsider how blood centers are paid.
“The model's broken—if you want a safe and available blood supply it's different than aspirin or penicillin,” Katz said. “It's an intrinsically difficult to procure natural resource that comes from individual donors—right now we're more like a commodity like pork bellies than a public utility.”