Praiseldy Langi Sasongko

103 Using a scenario approach to assess for the current and future demand of immunoglobulins 3.1 Introduction Since the early 2000s, intravenous immunoglobulins (IVIGs), pooled from the plasma of several thousand individuals, has been a “driver” in determining the demand for plasma for fractionation (PfF) based on medical needs.1 IVIG has become prominent for its efficacious ability to treat primary and secondary immune deficiencies and be an immunomodulatory agent for various other disorders.2–4 Over time, uses for IVIGs have increased as it is used for both registered (on-label) treatment and non-registered (off-label) treatments. Furthermore, administration of immunoglobulins (Igs) has expanded to subcutaneous (SCIg) and facilitated subcutaneous options (fSCIg).5–7 Thus, the global demand of Igs has increased dramatically over time, particularly in high-income countries.8 A report from MarketsandMarkets™ forecasted that the demand for Ig therapy increased approximately 8% globally and approximately 6% for Europe from 2016 to 2021.9 This growing demand leads to increasing costs and supply shortages, which are already occurring in the current system.2,10,11 Furthermore, in 2018, Europe obtained approximately 36% of PfF sourced from the United States,12 posing challenges for European self-sufficiency and continuity for the availability of these medicines. Research from the Marketing Research Bureau found that in 2018, the Netherlands was the 11th highest consuming country of Ig usage per capita.13 The Netherlands has experienced decreasing demand for erythrocyte concentrates14 which has resulted in fewer recovered plasma (plasma recovered from whole blood collection) and insufficient source plasma (plasma from apheresis). Therefore, with the historical and expected forecast of increased demand for Ig for the Netherlands,9 Sanquin, the Dutch national blood bank, needed to make decisions regarding its strategy for the future collection of plasma by assessing the future demand of Ig. Because Ig demand is a complex topic with various factors and stakeholders, quantitative predictions alone are insufficient and requires understanding of the current and future medical need. Therefore, we employed a scenario approach (also called scenario development or scenario planning) which has been used in other fields such as military, oil and transportation. It seeks to explore multiple plausible futures resulting from trends or policies and aids in long-term decision making to increase preparedness and proactivity for (un)expected future developments.15 This is done by including expert perspectives and systematically identifying relevant transformational factors (broadly defined as developments in society, technology, economy, ecology or politico-legal) that, in this case, may impact future Ig demand and to what effect (e.g., increase or decrease it).15,16 To the best of our knowledge, no study exists that includes qualitative methods in assessing demand, apart from

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