Cost‐effectiveness evaluation of the PROPPR trial transfusion protocols

BACKGROUND There have been no prior investigations of the cost effectiveness of transfusion strategies for trauma resuscitation. The Pragmatic, Randomized, Optimal Platelet and Plasma Ratios (PROPPR) study was a Phase III multisite, randomized trial in 680 subjects comparing the efficacy of 1:1:1 tr...

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Published in	Transfusion (Philadelphia, Pa.) Vol. 60; no. 5; pp. 922 - 931
Main Authors	Callcut, Rachael A., Simpson, Kit N., Baraniuk, Sarah, Fox, Erin E., Tilley, Barbara C., Holcomb, John B.
Format	Journal Article
Language	English
Published	Hoboken, USA John Wiley & Sons, Inc 01.05.2020 Wiley Subscription Services, Inc
Subjects	Adolescent Adult Blood Cell Count - economics Blood Platelets - cytology Blood Transfusion - economics Blood Transfusion - methods Blood Transfusion - mortality Blood Transfusion - statistics & numerical data Cost analysis Cost effectiveness Cost-Benefit Analysis Decision analysis Decision trees Erythrocyte Count Erythrocyte Transfusion - economics Erythrocyte Transfusion - methods Erythrocyte Transfusion - mortality Erythrocyte Transfusion - statistics & numerical data Erythrocytes Erythrocytes - cytology Female Hemorrhage Hemorrhage - blood Hemorrhage - mortality Hemorrhage - therapy Hemostasis Hemostatics Hospital costs Hospital Mortality Humans Length of Stay - economics Length of Stay - statistics & numerical data Life expectancy Life span Male Middle Aged Plasma - cytology Platelet Transfusion - economics Platelet Transfusion - methods Platelet Transfusion - mortality Platelet Transfusion - statistics & numerical data Platelets Resuscitation Resuscitation - mortality Resuscitation - statistics & numerical data State (computer science) Transfusion Trauma Young Adult
Online Access	Get full text
ISSN	0041-1132 1537-2995 1537-2995
DOI	10.1111/trf.15784

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Summary:	BACKGROUND There have been no prior investigations of the cost effectiveness of transfusion strategies for trauma resuscitation. The Pragmatic, Randomized, Optimal Platelet and Plasma Ratios (PROPPR) study was a Phase III multisite, randomized trial in 680 subjects comparing the efficacy of 1:1:1 transfusion ratios of plasma and platelets to red blood cells with the 1:1:2 ratio. We hypothesized that 1:1:1 transfusion results in an acceptable incremental cost‐effectiveness ratio, when estimated using patientsʼ age‐specific life expectancy and cost of care during the 30‐day PROPPR trial period. STUDY DESIGN AND METHODS International Classification of Diseases, Ninth Revision codes were prospectively collected, and subjects were matched 1:2 to subjects in the Healthcare Utilization Program State Inpatient Data to estimate cost weights. We used a decision tree analysis, combined with standard costs and estimated years of expected survival to determine the cost effectiveness of the two treatments. RESULTS The 1:1:1 group had higher overall costs for the blood products but were more likely to achieve hemostasis and decreased hemorrhagic death by 24 hours (p = 0.006). For every 100 patients treated in the 1:1:1 group, eight more achieved hemostasis than in the 1:1:2 group. At 30 days, the total hospital cost per 100 patients was $5.6 million in the 1:1:1 group compared with $5.0 million in the 1:1:2 group. For each 100 patients, the 1:1:1 group had 218.5 more years of life expectancy. This was at a cost of $2994 per year gained. CONCLUSION The 1:1:1 transfusion ratio in severely injured hemorrhaging trauma patients is a very cost‐effective strategy for increasing hemostasis and decreasing trauma deaths.
Bibliography:	Rachael Callcut is supported by a career development award from the NIH K01ES026834 and NIH R01HL149670. Source of funding: This work was sponsored by the US National Heart, Lung, and Blood Institute (U01HL077863) and the US Department of Defense, as well as Defense Research and Development Canada in partnership with the Canadian Institutes of Health Research (CIHR)‐ Institute of Circulatory and Respiratory Health (CRR‐120612). The National Heart, Lung, and Blood Institute and the Department of Defense were consulted regarding study design only. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Undefined-3 Systems Biology Committee: Alan Hubbard, PhD (co-Chair); Adam P. Arkin, PhD. University of Southern California: Kenji Inaba, MD; Jay G. Zhu, MD; Monica D. Wong, MS; Michael Menchine, MD, MPH; Kelly Katzberg, MD, FACEP; Sean O. Henderson, MD; Rodney McKeever, MD; Ira A. Shulman, MD; Janice M. Nelson, MD; Christopher W. Tuma, BA, MT(ASCP), SBB; Cheryl Y. Matsushita, BS, MT(ASCP). University of Arizona: Terence O’Keeffe, MBChB, MSPH; Laurel L. Rokowski, RN, BSN, MKT; Kurt R. Denninghoff, MD; Daniel T. Redford, MD; Deborah J. Novak, MD; Susan Knoll, MS, MT(ASCP) SBB. Oregon Health and Science University: Martin A. Schreiber, MD; Jennifer M. Watters, MD; Samantha J. Underwood, MS; Tahnee Groat, MPH; Craig Newgard, MD, MPH; Matthias Merkel, MD, PhD; Richard M. Scanlan, MD; Beth Miller, MT(ASCP)SBB. PROPPR Study Group Data Coordinating Center: Barbara C. Tilley, PhD; Sarah Baraniuk, PhD; Stacia M. DeSantis, PhD; Hongjian Zhu, PhD; Joshua Nixon, MS; Roann Seay, MS; Savitri N. Appana, MS; Hui Yang, MS; Michael O. Gonzalez, MS. University of Tennessee Health Science Center, Memphis: Timothy C. Fabian, MD; Jordan A. Weinberg, MD; Martin A. Croce, MD; Suzanne Wilson, RN; Stephanie Panzer-Baggett, RN; Lynda Waddle-Smith, BSN; Sherri Flax, MD. University of California, San Francisco: Mitchell Jay Cohen, MD (Systems Biology and Laboratory Committees co-Chair); Rachael A. Callcut, MD, MSPH; Mary Nelson, RN, MPA; Brittney Redick, BA; Amanda Conroy, BA; Marc P. Steurer, MD, DESA; Preston C. Maxim, MD; Eberhard Fiebig, MD; Joanne Moore; Eireen Mallari, MT. University of Alabama at Birmingham: Jeffrey D. Kerby, MD, PhD; Jean-Francois Pittet, MD (Anesthesia Chair); Patrick L. Bosarge, MD; Carolyn R. Williams, RN, BSN, BSME; Shannon W. Stephens, EMTP; Henry E. Wang, MD, MS; Marisa B. Marques, MD. Transfusion Committee: John R. Hess, MD, MPH (co-Chair); Jeannie L. Callum, MD (co-Chair). Sunnybrook Health Science Center: Sandro Rizoli, MD, PhD; Homer Tien, MD; Barto Nascimento, MD, MSc, CTBS; Sandy Trpcic; Skeeta Sobrian-Couroux, RN, CCRP, BHA; Marciano Reis; Adic Pérez, MD; Susan E. Belo, MD, PhD; Lisa Merkley, BA, MLT, CBTS; Connie Colavecchia, BSc, MLT. Clinical Coordinating Center: John B. Holcomb, MD; Charles E. Wade, PhD; Deborah J. del Junco, PhD; Erin E. Fox, PhD; Nena Matijevic, PhD (Laboratory Committee co-Chair); Jeanette M. Podbielski, RN; Angela M. Beeler, BS. University of Cincinnati: Peter Muskat, MD; Jay A. Johannigman, MD; Bryce R. H. Robinson, MD; Richard D. Branson, MSc, RRT; Dina Gomaa, BS, RRT; Christopher Barczak, BS, MT(ASCP); Suzanne Bennett, MD; Patricia M. Carey, MD; Christopher N. Miller, MD; Helen Hancock, BS, MT(ASCP); Carolina Rodriguez, BA. Shock, Trauma and Anesthesiology Research - Organized Research Center (STAR-ORC), R Adams Cowley Shock Trauma Center, University of Maryland Medical Center: Thomas M. Scalea, MD; Deborah M. Stein, MD, MPH; Cynthia K. Shaffer, MS, MBA; Christine Wade, BA; Anthony V. Herrera, MS; Seeta Kallam, MBBS; Sarah E. Wade, BS; Samuel M. Galvagno, Jr, DO, PhD; Magali J. Fontaine, MD, PhD; Janice M. Hunt, BS, MT(ASCP) SBB; Rhonda K. Cooke, MD. University of Washington: Eileen M. Bulger, MD; Patricia Klotz, RN; Lindsay Cattin, BA; Keir J. Warner, BS; Angela Wilson, BA; David Boman, BA; Nathan White, MD, MS; Andreas Grabinsky, MD; Jennifer A. Daniel-Johnson, MBBS. Resuscitation Outcomes Consortium: Gerald van Belle, PhD; Susanne May, PhD; Brian Leroux, PhD; David Hoyt, MD; Judy Powell, BSN, RN; Kellie Sheehan, BSN. PROPPR Clinical Sites (listed in order of number of patients enrolled) University of Texas Health Science Center at Houston: Bryan A. Cotton, MD, MPH; Laura Vincent, BSN, RN, CCRP; Timothy Welch; Tiffany Poole, DC; Evan G. Pivalizza, MD; Sam D. Gumbert, MD; Yu Bai, MD, PhD; James J. McCarthy, MD; Amy Noland, MD; Rhonda Hobbs, MT(ASCP)SBB. Core Laboratory: Lisa Baer, MS; Yao-Wei Willa Wang, MD; Brittany S. Hula, MS; Elena Espino, BS; An Nguyen, BS; Nicholas Pawelczyk, BS; Kisha D. Arora-Nutall, BS; Rishika Sharma, MD; Jessica C. Cardenas, PhD; Elaheh Rahbar, PhD; Tyrone Burnett, Jr., BS; David Clark, BS. Medical College of Wisconsin: Karen J. Brasel, MD, MPH; Pamela Walsh, AS, CCRC; David Milia, MD; Allia Nelson, BS, BA; Olga Kaslow, MD, PhD; Tom P. Aufderheide, MD, MS; Jerome L. Gottschall, MD; Erica Carpenter, MLS(ASCP).
ISSN:	0041-1132 1537-2995 1537-2995
DOI:	10.1111/trf.15784