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

Adam Irving, Alisa Higgins, Bridget Ady, Rinaldo Bellomo, D. James Cooper, Craig French, Dashiell Gantner, Anthony Harris, David O. Irving, Lynne Murray, Alistair Nichol, Dennis Petrie, Zoe K. McQuilten, 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

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)e572-e579
Number of pages8
JournalCritical Care Medicine
Volume47
Issue number7
DOIs
Publication statusPublished - 1 Jul 2019

Cite this

Irving, A., Higgins, A., Ady, B., Bellomo, R., Cooper, D. J., French, C., ... 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 (2019). 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. Critical Care Medicine, 47(7), e572-e579. https://doi.org/10.1097/CCM.0000000000003781
Irving, Adam ; Higgins, Alisa ; Ady, Bridget ; Bellomo, Rinaldo ; Cooper, D. James ; French, Craig ; Gantner, Dashiell ; Harris, Anthony ; Irving, David O. ; Murray, Lynne ; Nichol, Alistair ; Petrie, Dennis ; McQuilten, Zoe K. ; 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. / 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. In: Critical Care Medicine. 2019 ; Vol. 47, No. 7. pp. e572-e579.
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title = "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",
abstract = "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.",
author = "Adam Irving and Alisa Higgins and Bridget Ady and Rinaldo Bellomo and Cooper, {D. James} and Craig French and Dashiell Gantner and Anthony Harris and Irving, {David O.} and Lynne Murray and Alistair Nichol and Dennis Petrie and McQuilten, {Zoe K.} and {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}",
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Irving, A, Higgins, A, Ady, B, Bellomo, R, Cooper, DJ, French, C, Gantner, D, Harris, A, Irving, DO, Murray, L, Nichol, A, Petrie, D, McQuilten, ZK & 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 2019, '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' Critical Care Medicine, vol. 47, no. 7, pp. e572-e579. https://doi.org/10.1097/CCM.0000000000003781

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; Higgins, Alisa; Ady, Bridget; Bellomo, Rinaldo; Cooper, D. James; French, Craig; Gantner, Dashiell; Harris, Anthony; Irving, David O.; Murray, Lynne; Nichol, Alistair; Petrie, Dennis; McQuilten, Zoe K.; 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.

In: Critical Care Medicine, Vol. 47, No. 7, 01.07.2019, p. e572-e579.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Fresh red cells for transfusion in critically ill adults

T2 - an economic evaluation of the Standard Issue Transfusion versus Fresher Red-Cell Use in Intensive Care (TRANSFUSE) clinical trial

AU - Irving, Adam

AU - Higgins, Alisa

AU - Ady, Bridget

AU - Bellomo, Rinaldo

AU - Cooper, D. James

AU - French, Craig

AU - Gantner, Dashiell

AU - Harris, Anthony

AU - Irving, David O.

AU - Murray, Lynne

AU - Nichol, Alistair

AU - Petrie, Dennis

AU - McQuilten, Zoe K.

AU - 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

PY - 2019/7/1

Y1 - 2019/7/1

N2 - 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.

AB - 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.

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JF - Critical Care Medicine

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