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Sacrificing a cheap creature or even a token for the cost is best, but it can put you in a bit of a bind if your only creatures in play are too good to sacrifice or you dont have any creatures in play

And if your opponent is running low on life, even summoning sickness can't stop Bloodghast

The Reaper is certainly a powerful Commander if you wrap your head around your -1/-1 strategy, but I do think Auntie Ools card draw is the more compelling feature, as you might even be able to draw The Reaper, and other synergistic cards, by exploiting your Ward/Blight abilities

Considering how powerful the Sixth Doctor can be, it makes sense that this card has a relatively high mana value