(P-TA-16) Stagnating Utilization of Automated Red Blood Cell Exchange in the Management of Sickle Cell Disease

Background/Case Studies: Red blood cell exchange (RBCX) is a transfusion modality for patients with sickle cell disease (SCD) requiring chronic transfusion therapy. Unlike simple transfusion, RBCX minimizes iron accumulation, reduces hemoglobin S (HbS) to target thresholds more precisely, and lowers the risk of alloimmunization. Additionally, recent evidence shows RBCX can reduce hospitalization days and procedure burden and improve patient-reported outcomes. Despite these advantages, real-world adoption patterns in the United States remain poorly characterized.

Study

Design/Methods: Utilizing data pulled from Atlas All-Payor Claims, we estimated annual utilization rates of RBCX among patients with SCD from 2018 to 2023. Utilization was defined as the percentage of unique SCD patients who underwent RBCX each year. Linear regression was used to assess trends over time.

Results/Findings: RBCX utilization among patients with SCD remained static over the six-year period, ranging from a low of 1.64% in 2018 to 1.75% in 2020. Trend analysis revealed a non-significant slope (0.000004; P = 0.97), indicating no meaningful change in national utilization.

Conclusions: Despite extensive evidence that RBCX reduces the frequency and severity of vaso-occlusive crises, hospitalizations, and procedure time and improves life expectancy its use in the U.S. remains stagnant. These benefits were shown to be achievable even with peripheral access and minimal adverse events. The persistent underuse of RBCX likely reflects systemic barriers such as limited workforce capacity, inconsistent reimbursement policies, and insufficient access to apheresis infrastructure. To align practice with evidence, urgent investment is needed in care delivery infrastructure, workforce development, and policy reform. Future research should explore patient- and provider-level barriers to RBCX adoption, cost-effectiveness of broader implementation, and the impact of structured chronic exchange programs on long-term health equity in SCD.