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Fresh Red Cells for Transfusion in Critically Ill Adults: An Economic Evaluation of the Standard Issue Transfusion Versus Fresher Red-Cell Use in Intensive Care (TRANSFUSE) Clinical Trial

Irving, Adam MSc1; Higgins, Alisa MPH2; Ady, Bridget MClinResMeth2; Bellomo, Rinaldo MD2,3,4; Cooper, D. James MD2,5; French, Craig MB, BS2,4,6; Gantner, Dashiell MB, BS2,5; Harris, Anthony1; Irving, David O.7; Murray, Lynne BAppSci2; Nichol, Alistair PhD2,5; Petrie, Dennis1; McQuilten, Zoe K. PhD2,8; on behalf of the Standard Issue Transfusion versus Fresher Red-Cell Use in Intensive Care (TRANSFUSE) Investigators and Australian and New Zealand Intensive Care Society Clinical Trials Group

doi: 10.1097/CCM.0000000000003781
Online Clinical Investigations
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Objectives: Trials comparing the effects of transfusing RBC units of different storage durations have considered mortality or morbidity as outcomes. We perform the first economic evaluation alongside a full age of blood clinical trial with a large population assessing the impact of RBC storage duration on quality-of-life and costs in critically ill adults.

Design: Quality-of-life was measured at 6 months post randomization using the EuroQol 5-dimension 3-level instrument. The economic evaluation considers quality-adjusted life year and cost implications from randomization to 6 months. A generalized linear model was used to estimate incremental costs (2016 U.S. dollars) and quality-adjusted life years, respectively while adjusting for baseline characteristics.

Setting: Fifty-nine ICUs in five countries.

Patients: Adults with an anticipated ICU stay of at least 24 hours when the decision had been made to transfuse at least one RBC unit.

Interventions: Patients were randomized to receive either the freshest or oldest available compatible RBC units (standard practice) in the hospital transfusion service.

Measurements and Main Results: EuroQol 5-dimension 3-level utility scores were similar at 6 months—0.65 in the short-term and 0.63 in the long-term storage group (difference, 0.02; 95% CI, –0.00 to 0.04; p = 0.10). There were no significant differences in resource use between the two groups apart from 3.0 fewer hospital readmission days (95% CI, –5.3 to –0.8; p = 0.01) during follow-up in the short-term storage group. There were no significant differences in adjusted total costs or quality-adjusted life years between the short- and long-term storage groups (incremental costs, –$2,358; 95% CI, –$5,586 to $711) and incremental quality-adjusted life years: 0.003 quality-adjusted life years (95% CI, –0.003 to 0.008).

Conclusions: Without considering the additional supply cost of implementing a freshest available RBC strategy for critical care patients, there is no evidence to suggest that the policy improves quality-of-life or reduces other costs compared with standard transfusion practice.

1Centre for Health Economics, Monash Business School, Monash University, Caulfield, VIC, Australia.

2Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

3Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia.

4Centre for Integrated Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.

5Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia.

6Department of Intensive Care, Western Health, Melbourne, VIC, Australia.

7Research and Development, Australian Red Cross Blood Service, Kelvin Grove, QLD, Australia.

8Department of Haematology, Monash Health, Clayton, VIC, Australia.

This work was performed at the Centre for Health Economics, Monash Business School, Monash University, Caulfield, VIC, Australia.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

The full list of board members of the Standard Issue Transfusion versus Fresher Red-Cell Use in Intensive Care (TRANSFUSE) Investigators is provided in the Supplementary Appendix (Supplemental Digital Content 1, http://links.lww.com/CCM/E540).

The TRANSFUSE trial was supported, in part, by grants from the Australian National Health and Medical Research Council (APP102064 and APP1040971), the Health Research Council of New Zealand (12/575), and the Irish Health Research Board (HRA-DI-2015–589 and CTN-2014-012) and by funding from the Australian Red Cross Blood Service.

Ms. Higgins’s and Ms. Murray’s institutions received funding from Australian National Health and Medical Research Council (NHMRC) and Australian Red Cross Blood Service. Drs. Cooper’s and Gantner’s institutions received funding from NHMRC, Health Research Council of New Zealand, and Irish Health Research Board, and they received other support from Australian Red Cross Blood Service. Dr. Cooper received funding from Eustralis Pharmaceuticals (consulting) and National Blood Authority, Australia. Dr. French’s institution received funding from NHMRC. Dr. Irving’s institution received funding from the Australian Government (via the National Blood Authority). Dr. McQuilten’s institution received funding from Abbvie, Celgene, Janssen-Cilag, CSL Biotherapies, and Gilead Sciences (for research undertaken by the Transfusion Research Unit). The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Zoe K. McQuilten, PhD, Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia. E-mail: zoe.mcquilten@monash.edu

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