Centre for Health Economics, Monash Business School, Monash University, Caulfield, VIC, Australia.
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Crit Care Med. 2019 Jul;47(7):e572-e579. doi: 10.1097/CCM.0000000000003781.
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.
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.
Fifty-nine ICUs in five countries.
Adults with an anticipated ICU stay of at least 24 hours when the decision had been made to transfuse at least one RBC unit.
Patients were randomized to receive either the freshest or oldest available compatible RBC units (standard practice) in the hospital transfusion service.
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).
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.
比较不同储存时间的红细胞单位输注效果的试验将死亡率或发病率作为结局。我们进行了第一次经济评估，同时对一项大型的全年龄段血液临床试验进行了评估，该试验评估了红细胞储存时间对危重症成人生活质量和成本的影响。
使用 EuroQol 5 维度 3 级工具在随机分组后 6 个月测量生活质量。经济评估考虑了从随机分组到 6 个月的质量调整生命年和成本影响。使用广义线性模型分别估计增量成本（2016 年美元）和质量调整生命年，同时调整基线特征。
五个国家的 59 个 ICU。
当决定输注至少一个红细胞单位时，预计 ICU 停留时间至少为 24 小时的成年人。
患者随机分配接受医院输血服务中最新或最旧的相容红细胞单位（标准做法）。
6 个月时 EuroQol 5 维度 3 级效用评分相似-短期为 0.65，长期为 0.63（差异为 0.02；95%CI，-0.00 至 0.04；p = 0.10）。除了短期储存组在随访期间住院再入院天数减少 3.0 天（95%CI，-5.3 至-0.8；p = 0.01）外，两组之间的资源使用没有显著差异。短期和长期储存组之间的总调整成本或质量调整生命年没有显著差异（增量成本，-$2358；95%CI，-$5586 至$711）和增量质量调整生命年：0.003 质量调整生命年（95%CI，-0.003 至 0.008）。
在不考虑实施最新型红细胞策略为危重症患者提供额外供应成本的情况下，没有证据表明该政策与标准输血实践相比能提高生活质量或降低其他成本。
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