Prophylactic platelet transfusions in patients with blood malignancies: cost analysis of a randomized trial
Background This cost analysis uses data from a randomized trial comparing a no prophylaxis versus prophylactic platelet (PLT) transfusion policy (counts <10 × 109/L) in adult patients with hematologic malignancies. Results are presented for all patients and separately for autologous hematopoietic...
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Published in | Transfusion (Philadelphia, Pa.) Vol. 54; no. 10; pp. 2394 - 2403 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
Hoboken, NJ
Blackwell Publishing Ltd
01.10.2014
Wiley Wiley Subscription Services, Inc |
Subjects | |
Online Access | Get full text |
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Summary: | Background
This cost analysis uses data from a randomized trial comparing a no prophylaxis versus prophylactic platelet (PLT) transfusion policy (counts <10 × 109/L) in adult patients with hematologic malignancies. Results are presented for all patients and separately for autologous hematopoietic stem cell transplantation (HSCT) (autoHSCT) and chemotherapy/allogeneic HSCT (chemo/alloHSCT) patients.
Study Design and Methods
Data were collected to 30 days on PLT and red blood cell (RBC) transfusions, major bleeds, serious adverse events, critical care, and hematology ward stay. Data were costed using 2011 to 2012 UK unit costs and converted into US$. Sensitivity analyses were performed on uncertain cost variables.
Results
Across the whole trial no prophylaxis saved costs compared to prophylaxis: −$1760 per patient (95% confidence interval [CI], −$3250 to −$249; p < 0.05). For autoHSCT patients there was no cost difference between arms: −$110 per patient (95% CI, −$1648 to $1565; p = 0.89). For chemo/alloHSCT patients no prophylaxis cost significantly less than prophylaxis: −$5686 per patient (95% CI, −$8580 to −$2853; p < 0.01). The cost impact of no prophylaxis differed significantly between subgroups. Sensitivity analyses varying daily treatment costs and ward stay for chemo/alloHSCT patients reduced cost differences to −$941 per patient (p = 0.21) across the whole trial and −$2927 per patient (p < 0.05) in chemo/alloHSCT subgroup.
Conclusions
It is unclear whether a no‐prophylaxis policy saves costs overall. In chemo/alloHSCT patients cost savings are apparent but their magnitude is sensitive to a number of variables and must be considered alongside clinical data showing increased bleeding rates. In autoHSCT patients savings generated through lower PLT use in no‐prophylaxis arm were offset by cost increases elsewhere, for example, additional RBC transfusions. Cost‐effectiveness analyses of alternative PLT transfusion policies simultaneously considering costs and patient‐reported outcomes are warranted. |
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Bibliography: | National Institute for Health Research (NIHR) Oxford Biomedical Research Centre at Oxford University Hospitals NHS Trust National Health Service Blood and Transplant Research and Development Committee - No. PG04-5 ark:/67375/WNG-XBCRV2B5-C Fig. S1. Breakdown of daily cost ($US 2011/2012) of inpatient medications and investigations from 162 patients (without SAE or major bleed) from two UK TOPPS trial centers. Table S1. Unit costs used to value resource use data in the TOPPS Trial Table S2. Summary of data for 8 patients who suffered a SAE and for whom detailed inpatient resource use were available Table S3. Baseline characteristics and primary outcome by trial arm and treatment sub-group Table S4. Resource use per patient by trial arm for each subgroup ArticleID:TRF12697 Australian Red Cross Blood Service University of Oxford NHSBT/MRC Clinical Studies Unit istex:83DE6C6282437C76959665AD3C8E37DDE9DC809A ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-News-2 ObjectType-Feature-3 content type line 23 |
ISSN: | 0041-1132 1537-2995 |
DOI: | 10.1111/trf.12697 |