Managing blood supply

Blood and blood products are a critical component of health care. The NBA manages the national blood supply to ensure that:

• healthcare providers have reliable and efficient access to blood and blood products needed for patient care
• value for money is achieved.

The Australian, state and territory governments spend more than $1.7 billion a year on blood and blood products. These are provided at no cost to patients based on clinical need and appropriate clinical practice.

Australian Red Cross Lifeblood(Opens in a new tab/window) (Lifeblood) needs more than 1.6 million donations each year to ensure a reliable blood supply for Australians who need it.

Fresh blood products come directly from Lifeblood. CSL Behring makes most of Australia's plasma-derived products from plasma collected by Lifeblood under the National Fractionation Agreement for Australia.

We also need to purchase blood products from overseas. These products are either not made in Australia, or Australia is unable to produce enough to meet demand.

What we do to manage blood supply

The NBA ensures a secure supply of blood and blood products in Australia by:

• working with states and territories to determine and manage an annual supply plan and budget
• negotiating and managing blood supply contracts and arrangements with local and overseas suppliers
• administering payments to suppliers based on funding and supply contracts
• supporting decisions of funding governments by evaluating proposals to add, remove or change blood products on the National Product Price List
• establishing risk and contingency management arrangements, including planning for times of supply shortage
• managing Australia's access to government-funded immunoglobulin products.

Monitoring product use

The NBA conducts utilisation reviews to understand usage patterns of products listed on the National Product Price List (NPPL).  Utilisation reviews examine key aspects of product use including prescribing, ordering, dispensing and administration. This help ensure that products are appropriately used in view of pre-determined criteria such as approved funding indications.

C1-esterase inhibitor concentrate utilisation review

C1-esterase inhibitor concentrate (C1-INH) is one of the available treatment options for hereditary angioedema (HAE), a rare genetic condition caused by insufficient or partially inactive C1-esterase inhibitor. HAE causes swellings, or attacks, that can cause death and severely impact on patients’ ability to participate in the community without appropriate treatment due to their unpredictability.

C1-INH was added to the NPPL in 2016 as a second line treatment for acute HAE attacks, for long term prophylaxis in patients experiencing eight or more attacks per month, and for short term prophylaxis prior to undergoing high risk head and neck surgery. The NBA supplies the C1-INH product Berinert (CSL Behring) under the national blood arrangements.

In 2021, the NBA conducted a preliminary utilisation review of C1-INH which identified an unanticipated increase in C1-INH use.  In 2023, a full independent utilisation review (the C1-INH review) was subsequently conducted with the aim of identifying factors driving increased demand and determining whether increased demand is appropriate in the context of funded access.

The C1-INH review found that increased demand for C1-INH was influenced by the withdrawal of the first line prophylactic treatment from the Australian market, followed by the introduction of a new subcutaneous form of C1-INH that was considered by clinicians and patients to be a superior product. 

To address the issues identified in the review, it was recommended that the NBA:

• review the system of governance for ordering and recording the supply of NBA funded C1‑INH; and
• review the guidelines for accessing NBA funded C1-INH.

Actions to address the recommendations from the C1-INH review are underway.

The Executive Summary of the C1-INH utilisation review can be found here.

Eptacog alfa (NovoSeven) utilisation review

Eptacog alfa (recombinant coagulation Factor VIIa - NovoSeven) is one of the available treatment options for some patients with haemophilia A or B inhibitors, congenital Factor VII deficiency and Glanzmann’s thromasthenia. It is funded under the national blood arrangements for the control of bleeding and prophylaxis in patients. 

A review into the utilisation of Factor VIIa was conducted by the NBA in 2022 to determine whether its use is consistent with the criteria for NBA funded access. Findings of the review include that the volume of Factor VIIa distributed between 2015-2021 is steady and predictable, and the volume issued to patients is consistent with a stable patient population. Overall, the review found that Factor VIIa is being used appropriately for the treatment of bleeding disorders.

The Eptacog alfa utilisation review can be found here.

Get in touch

For more information about how the NBA manages blood supply, please contact us.