Scenario 2: consolidating processing and testing

The aim of this scenario is the consolidation of processing, testing and mobile collection to optimize the use of resources (both donor blood and equipment). Scenario is based on the current legal status, i.e. blood centres being structural units of hospitals. Today, there is already cooperation between blood centres in testing and ordering specific blood products and platelets for Pärnu and Ida-Viru hospitals. DESCRIPTION AND JUSTIFICATION OF SCENARIO

New division of responsibilities: two blood centres and one stationary donor centre (q.v. figure 19)  Blood collection: two blood centres in Tallinn and Tartu and a donor centre in Pärnu. Mobile

collection is organized from both blood centres, incl. into current locations of Pärnu and Ida-Viru from Tallinn.

 Testing, processing and distribution: two centres in Tallinn and Tartu.

Tallinn blood centre Pärnu blood centre Tartu blood centre Ida-Viru blood centre Collecting Testing Processing Distribution Hospitals in South Estonia Hospitals in North, Central and West Estonia Pärnu hospital Hospitals in Ida-Viru county In centre In district

Figure 18. Division of responsibilities in Estonian blood service: scenario 2

Note: light gray lines show movement which will disappear compared to current system and dark grey indicate new movements.

The organization of mobile collection is assembled into two centres as there is no greater difference from the cost aspect, where the car heads back to, therefore it is more reasonable to gather the collected blood into one-two locations. Visits to current locations in Pärnu and Ida-Viru district will be done from Tallinn, the staff from the donor centre should be involved in some of the mobile collection visits (in cases the location is close to the donor centre, which saves the time resources of the staff). Gathering the collected blood from mobile collection to PERH blood centre results from their sufficient facilities.

Pärnu donor centre would only collect whole blood as obtaining an aphaeresis device is not very cost- effective with the small amount of collection. The collected blood is transported to Tallinn daily. Ida-Viru would not have a stationary blood collection facility due to the small amount of donations – currently the

centre collects 800 whole blood doses annually, i.e. an average of 3 donors a day visits the Ida-Viru blood centre. An alternative could be collecting blood at the hospital blood bank or creating a stationary blood collection point in a different location in the area (e.g. Rakvere), but this adds daily transportation costs to Tallinn and the solution would require separate analysis.

The reason for concentrating mobile collection, but also processing and testing, is to optimise the use of resources (blood vehicles, equipment, staff, facilities) – concentrating main activities enables a better quality management as well. Gathering processing into two centres enables to optimise the use of donor blood and simplifies the transition to inactivated products nation-wide, in case inactivation in blood centres is decided upon (this is implied to in the evaluation of Estonian Health Insurance Fund, which states that this method is more cost-effective compared to Octaplas). Processing in two centres helps to diversify the risks.

IMPACTS OF THE SCENARIO

Estimated impacts on the amount and quality of blood products:  number of collected donations remains the same;  preparation of platelets increases (estimation of 20%5);

 quality improves due to improvement in quality management as main activities are consolidated;  if inactivation is introduced in two centres (not reasonable in four centres), the safety of blood

products improves nation-wide;

 no reason to think that the availability of blood products decreases in Pärnu, Ida-Viru and Narva hospitals, since the ordering and storing of blood products can be organized similarly to other hospitals.

Estimated financial impacts and investment need

In estimating the financial impacts, the expenses related to the expansion of PERH blood centre (increase in staff, new equipment, etc) and the costs related to changes in the tasks of Pärnu and Ida-Viru blood centres were taken into consideration. Only the costs which appear or disappear with the changes in division of responsibilities were considered, but not the transition of costs from one centre to another (e.g. material costs). Cost estimation does not include possible revenue from unnecessary equipment (sales value or saved rental costs) or avoided future investments in Pärnu and Ida-Viru blood centres (renewal of facilities and equipment, developments like EVI). In addition, external factors (inflation, increase in maintenance prices of equipments, etc) and external effects of blood service (e.g. increasing transportation costs in Pärnu, Ida-Viru and Narva hospitals) were not considered. The transition time of the new system is assumed 1 year and 3 months. The assumptions made for calculations are shown in Annex 9.

5

Currently Tartu and PERH blood centres prepare 5600 BC platelets doses from 48 000 whole blood doses. Majority is 4BC platelets (~90% of used BC platelets), therefore 5600/(48 000/4)=47% of the potential use is prepared. By adding 10 000 whole blood doses, 10 000/4*47/=1100 doses can be prepared, increase of 20%.

Table 31. Changes in total costs due to the new division of responsibilities (thousand Euros): scenario 2

2013 2014 2015 2016 2017 2018 2019 2020 TOTAL

Non-recurring costs 61.9 25.6 87.6

.. costs related to re-location 35.9 25.6 61.6 ..purchase of equipment 26.0 26.0

Recurring costs 72.9 72.9 72.9 72.9 72.9 72.9 72.9 510.4

.. recruiting new employees 59.8 59.8 59.8 59.8 59.8 59.8 59.8 418.6 ..maintenance of new equipment 0.3 0.3 0.3 0.3 0.3 0.3 0.3 2.1 ..increase in transportation costs 12.8 12.8 12.8 12.8 12.8 12.8 12.8 89.8

TOTAL COSTS 61.9 98.6 72.9 72.9 72.9 72.9 72.9 72.9 598.0

Annual savings ─177.2 ─236.3 ─236.3 ─236.3 ─236.3 ─236.3 ─236.3 ─1 594.7

..decrease in costs on salaries ─149.9 ─199.9 ─199.9 ─199.9 ─199.9 ─199.9 ─199.9 ─1 349.3 ..decrease in maintenance and

rental costs of equipment and facilities

─15.2 ─20.3 ─20.3 ─20.3 ─20.3 ─20.3 ─20.3 ─137.0 .. decrease in management costs ─12.0 ─16.1 ─16.1 ─16.1 ─16.1 ─16.1 ─16.1 ─108.4

TOTAL 61.9 ─78.6 ─163.3 ─163.3 ─163.3 ─163.3 ─163.3 ─163.3 ─996.7

According to the estimation, the change in the division of responsibilities pays off in 1.75 years. After re- arrangements the annual savings is 163 thousand Euros and the operating costs of blood service would be 6.9 million Euros by 2020. After 8 years, the savings resulting from changes in division of responsibilities is almost a million Euros. It should be emphasized that this is a conservative estimation, as the significant savings arising from losing investment needs in two blood centres are not included in the estimation. Table 32. Estimated operating costs of Estonian blood service (thousand Euros): scenario 2

2013 2014 2015 2016 2017 2018 2019 2020

Scenario 1: current division of responsibilities

6 076 6 208 6 343 6 480 6 620 6 764 6 910 7 060 Scenario 2: consolidated

processing and testing 6 138 6 130 6 179 6 317 6 457 6 601 6 747 6 897

This scenario is more cost-effective compared to the current division of responsibilities as it brings forth savings, the amount of collected blood does not decrease, the processing of platelets might increase and prerequisites for improving the quality of products are created.

8.3.3.

Scenario 3: centralized (national) blood service with two blood