Are we optimising outcomes in Australia’s framework for the supply of plasma-derived medicines?

Australian governments endorse a policy for the evidence-based supply of plasma derivatives, which are procured from domestically collected plasma and managed through contracts between the National Blood Authority and the collection and fractionation agencies. In Australia, these are the Australian Red Cross and CSL Behring respectively. Historically, these organisations have been granted a sole supplier status by Australian governments and their activities, unlike most arrangements for service provision, have not been subject to the mainstream tender processes for government procurement.

A review conducted by the Australian government in 20061,2 concluded that the single supplier arrangement for manufacturing plasma in a domestic factory was to stand and would not be subject to possible competition from international organisations. This system generates a potential surplus of other products not needed in Australia. In particular, the government’s decision, in 2004, to fund the provision of imported recombinant coagulation factors used to treat haemophilia has generated a substantial surplus of antihaemophilic factor, which, through discarding the primary cryoprecipitate fraction, is currently not used.

Recent international developments in plasma fractionation arrangements cast some doubt as to whether the system endorsed by the Flood review1 still represents the best option for Australia. The publicly available information regarding the pricing of contract plasma fractionation indicates that the fractionation services provided by CSL Behring cost the Australian system $420 per kg of plasma.3 In Italy, in a recent competitive tender for similar plasma fractionation services, the same company won the contract through a bid of €94.6 (about $140) per kg of plasma.4 In addition, in other countries, such as Canada5 and Italy,6 cryoprecipitate surplus is further fractionated to concentrate, which is then donated to humanitarian programs to ensure that altruistically donated plasma derivatives are not wasted. There has been little indication that Australian governments have a policy for a similar program to manage the surplus, particularly for antihaemophilic factor. Scarce health care resources, including freely donated blood, should be managed with care, and the example of other countries should be noted by Australian decision makers charged with ensuring full value for the health dollar.