• 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, and Standard Issue Transfusion versus Fresher Red-Cell Use in Intensive Care (TRANSFUSE) Investigators and Australian and New Zealand Intensive Care Society Clinical Trials Group.
• Centre for Health Economics, Monash Business School, Monash University, Caulfield, VIC, Australia.
• Crit. Care Med. 2019 Jul 1; 47 (7): e572-e579.

ObjectivesTrials 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.DesignQuality-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.SettingFifty-nine ICUs in five countries.PatientsAdults with an anticipated ICU stay of at least 24 hours when the decision had been made to transfuse at least one RBC unit.InterventionsPatients were randomized to receive either the freshest or oldest available compatible RBC units (standard practice) in the hospital transfusion service.Measurements And Main ResultsEuroQol 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).ConclusionsWithout 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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