TOPLINE:

In a trial-based economic evaluation, cryopreserved platelets were more costly and less effective than standard therapy with liquid-stored platelets for managing active bleeding in patients undergoing cardiac surgery. Use of cryopreserved platelets was associated with higher per-patient costs and with greater postoperative bleeding volumes and higher mortality rates.

METHODOLOGY:

• Platelet transfusion is essential for major bleeding, but liquid-stored platelets have a 5- to 7-day shelf life that limits availability in regional settings. Cryopreserved platelets last up to 2 years and may provide a solution for hospitals facing limited access to platelets; however, their cost-effectiveness and clinical outcomes remain uncertain. This study evaluated the cost-effectiveness of cryopreserved vs liquid-stored platelets as part of the CLIP-II trial.
• Researchers conducted an economic evaluation as part of the CLIP-II trial involving 202 adult patients (median age, 66 years; 75.7% men) at a high risk of requiring platelet transfusion during cardiac surgery. Participants were randomly assigned to receive at least 3 units of either cryopreserved (n = 104) or liquid-stored (n = 98) platelets intraoperatively or within 24 hours post-surgery.
• Researchers analyzed costs in 2023 Australian dollars by assigning unit costs to patient-level resource use, including ICU admissions, hospitalizations, and use of blood products.
• Primary effectiveness measures included bleeding volume in the first 24 hours after ICU admission, total volume of postoperative bleeding, 90-day mortality, Bleeding Academic Research Consortium (BARC) type 4 bleeding events, and serious adverse events. The cost-effectiveness of cryopreserved vs liquid-stored platelets was assessed by comparing the mean costs and health outcomes between treatment groups.

TAKEAWAY:

• The mean total cost per patient was AUD $81,029 in the cryopreserved platelet group vs AUD $65,993 in the liquid-stored platelet group, producing a mean difference of AUD $15,035. This finding indicates that patients using cryopreserved platelets for postoperative bleeding incurred higher overall costs than those using standard therapy with liquid-stored platelets.
• Regarding health outcomes, mean blood loss within 24 hours post-ICU admission was 121 mL greater and total postoperative blood loss was 504 mL greater with cryopreserved platelets than with liquid-stored platelets. Similarly, BARC type 4 bleeding was greater in the cryopreserved platelet group (31.7% vs 19.4% of patients; absolute difference, 12.3%), as was the 90-day mortality rate (12.5% vs 5.1% of patients; absolute difference, 7.4%).
• Looking at individual resource use and costs, index ICU costs were higher with cryopreserved platelets (AUD $36,615 vs AUD $24,803; difference, AUD $11,812). The unit cost and use of study platelets were substantially greater (AUD $3211 vs AUD $400; difference, AUD $2811), and recipients of cryopreserved platelets required an additional 0.9 units of nonstudy platelets on average and received more red blood cells and plasma.
• In adjusted probabilistic (bootstrapped) analyses, cryopreserved platelets were dominated by liquid-stored platelets (ie, higher costs and worse outcomes). The adjusted incremental cost was AUD $12,791 for both 24-hour ICU bleeding and total postoperative bleeding, with adjusted incremental effects of -91 mL and -324 mL, respectively. Adjusted incremental effects were -12.2% for BARC type 4 bleeding and -6.6% for 90-day mortality, with an adjusted incremental cost of AUD $12,738 per 1% reduction for each outcome.

IN PRACTICE:

“This economic evaluation found that among patients undergoing cardiac surgery in metropolitan hospitals in Australia, standard therapy with liquid-stored platelets was more effective and cost-efficient than cryopreserved platelets for managing active bleeding,” the authors wrote, adding that “further evaluation of the potential costs and benefits of cryopreserved platelets implementation in regional and remote settings may be warranted to ensure equitable access to emergency bleeding management across the country.”

SOURCE:

The study, led by Zhomart Orman, PhD, Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University in Melbourne, Australia, was published online in JAMA Network Open.

LIMITATIONS:

The study population was relatively homogeneous due to strict inclusion and exclusion criteria, potentially limiting generalizability to broader cardiac surgery populations. Data on resource use were collected from high-resource metropolitan hospitals, which may not have reflected cost structures and clinical practices in regional and remote settings. ICU cost weights by organ support were estimated using UK data because Australian equivalents were not available, which may have introduced imprecision. Additionally, costs of cryopreserved platelet production were estimated from trial production and may not reflect routine-scale manufacturing efficiencies.

DISCLOSURES:

The study was funded by the Australian National Health and Medical Research Council and Australian Red Cross Lifeblood. One author reported serving in the Australian Defence Force during the conduct of the study. No other disclosures were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.