Cost-effectiveness evaluation of the PROPPR trial transfusion protocols

Area of Science:

• Trauma Resuscitation
• Transfusion Medicine
• Health Economics

Background:

• No prior studies evaluated cost-effectiveness of transfusion strategies in trauma resuscitation.
• The Pragmatic, Randomized, Optimal Platelet and Plasma Ratios (PROPPR) study compared 1:1:1 and 1:1:2 ratios of plasma and platelets to red blood cells.
• Hypothesis: 1:1:1 ratio is cost-effective using age-specific life expectancy and 30-day trial costs.

Purpose of the Study:

• To determine the cost-effectiveness of a 1:1:1 transfusion ratio compared to a 1:1:2 ratio in trauma resuscitation.
• To analyze the incremental cost-effectiveness ratio (ICER) of the 1:1:1 strategy.
• To evaluate the impact on hemostasis, mortality, and life expectancy.

Main Methods:

• Phase III, multisite, randomized trial (PROPPR) with 680 subjects.
• International Classification of Diseases, Ninth Revision codes used for cost weighting via matching to Healthcare Utilization Program data.
• Decision tree analysis combined with standard costs and estimated survival years.

Main Results:

• The 1:1:1 group showed higher costs for blood products but improved hemostasis and reduced hemorrhagic death by 24 hours (p=0.006).
• For every 100 patients, 1:1:1 achieved hemostasis in 8 more patients.
• At 30 days, 1:1:1 cost $5.6M vs $5.0M for 1:1:2 per 100 patients, yielding 218.5 more life-years at $2994/year gained.

Conclusions:

• The 1:1:1 transfusion ratio is a highly cost-effective strategy for severely injured, hemorrhaging trauma patients.
• This ratio improves hemostasis and decreases trauma-related deaths.
• The strategy provides significant gains in life expectancy at an acceptable incremental cost.