Cost-Effectiveness of Cryopreserved vs Liquid-Stored Platelets for Managing Surgical Bleeding

Area of Science:

• Hematology
• Health Economics
• Surgical Innovation

Background:

• Liquid-stored platelets have a short shelf-life (5-7 days), limiting availability.
• Cryopreserved platelets offer extended storage (up to 2 years), potentially improving access.
• The cost-effectiveness of cryopreserved platelets versus liquid-stored platelets remains uncertain.

Purpose of the Study:

• To evaluate the cost-effectiveness of cryopreserved platelets compared to liquid-stored platelets for managing surgical bleeding.
• To assess clinical outcomes associated with cryopreserved versus liquid-stored platelet transfusions in cardiac surgery.

Main Methods:

• Economic evaluation alongside the CLIP-II randomized clinical trial (Australian government funder perspective).
• Adult patients undergoing cardiac surgery at high risk for platelet transfusion were included.
• Participants received either cryopreserved or liquid-stored platelets; costs and effectiveness (bleeding, mortality, adverse events) were measured.

Main Results:

• Cryopreserved platelets resulted in higher per-patient costs (mean difference A$15,035).
• Increased postoperative blood loss (24h ICU admission and total) and higher rates of type 4 bleeding were observed with cryopreserved platelets.
• No statistically significant difference in 90-day mortality or serious adverse events between groups.

Conclusions:

• In this economic evaluation, liquid-stored platelets dominated cryopreserved platelets for managing bleeding in cardiac surgery.
• Further research is recommended to assess cryopreserved platelets' economic benefits in broader populations, especially in resource-limited settings.
• Cryopreserved platelets may have potential in specific scenarios like regional hospitals with limited platelet availability.