Friday, July 15, 2011

Blood Money: The economics of America's most common deadly genetic disorder

Blood costs money and I know where to get a lot of it, blood that is. Now that might sound callous but it's true and it could save a lot of lives as well as pump more than a billion dollars into the American economy. Please bear with me as I explain, and please pardon the pumping pun.

For several decades now, the supply of fresh human blood in America has been getting tighter, pushing the cost of blood-consuming medical procedures higher and higher. Expanding the nation's blood supply would not only reduce pain and suffering, it would have a positive economic impact. Taking a cold, hard, economic look at anything related to the health and well-being of our fellow beings is bound to bother some people, but the path to sustainable caring-giving within the boundaries of economic reality requires us to acknowledge that things like blood cost money.

While most of the blood supply in America is freely donated, the logistics of blood taking and storage are not free, indeed they are quite expensive. So the cost of a unit of blood is something like $150 or more. Why is that number so vague? Because the cost varies according to supply and demand and those vary by location. In the heartland of America, the supply is high relative to demand but the reverse tends to be true on the coasts. A fairly recent number quoted by a medical facility on the East coast is $175 per unit. That number goes down when supply goes up, but not all the way down since there are fixed costs like testing the blood (there's more detail here).

The extent to which an increase in the supply of blood would reduce the cost to those that need it is hard to determine and I have not yet found any research on that. So let's run with 20% of the $175 number ($35) and find out where the nation can save/make a whole bunch of money. There are probably at least 13 million Americans that have the potential for homozygous or compound heterozygous variations of the HFE gene. In English that means they are at risk of developing toxic levels of iron in their bodies due to "iron overloading" caused by something called hemochromatosis, the most common, potentially-fatal, genetic disorder in America.

The best defense against hemochromatosis is to give blood regularly. Let's say 6 times per year. Suppose that 45% of those 13 million people would become regular blood donors if they found out they had hemochromatosis (that's adjusting down from 100% for those that already know, those that already give blood, and those who have a hard time giving blood). According to my spreadsheet that comes out to $1.25 billion per year, $12.5 billion over the next decade. I can't resist saying that's quite a shot in the arm for our economy.

But that is just the beginning...encouraging more people to give blood in general could have a fantastic prophylactic effect IF blood banks would routinely run an iron panel on donors to screen for iron overload, the most telling sign of possible hemochromatosis. People found to have high iron levels could check in with their doctors and might also elect to get a genetic test to detect hereditary hemochromatosis ($99* from 23andMe). The iron panel is a relatively inexpensive blood test and before 1996 it was fairly routine.

(Don't get me started on the slimy corporate frauds whose greed caused iron to be dropped from the standard blood panel, leading to a significant drop in the rate of hemochromatosis detection and thus a tragically avoidable rise in human suffering.)

The fact is, early detection of hemochromatosis would save our economy billions in avoidable health care costs, disability costs, lost productivity and tax revenues. On top of that, early detection, combined with affordable genetic testing, awareness and counseling, could lead to the eventual disappearance of this condition.

The genetic form of iron overload probably occurred as a natural defense against a diet low in iron and the shift from a nomadic, hunting-based culture to city life made possible by the agrarian-revolution. Now, in a world of iron-rich diets and lifespans that extend past menopause, genetic hemochromatosis has become a life-threatening metabolic disorder. Let's get rid of it and save a lot of money, and a lot of human suffering.
Note:  Due to ignorance, many blood banks throw away blood from hemochromatosis patients or even charge them for “filtering.” This is infuriating, immoral, and should be illegal. The FDA is quite clear that the blood is good, and so is the NIH Clinical Center.

1 comment:

  1. I was just diagnosed with Hemochromatosis a few days ago and was planning to move back to America. Problem being I don't have health insurance there and with this disease I will need frequent treatment for the first few months or even possibly years. I'd be happy to give my blood to others and save America money if they'd insure me!

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