Plasma Transfusion Demystified: A Review of the Key Factors Influencing the Response to Plasma Transfusion

Aw, Bryan; Staley, Elizabeth M.; Kennell, Timothy; Feldman, Alexander; Williams, Lance A.; Hp, Pham

doi:10.1093/labmed/lmx027

Cited by 18 publications

(8 citation statements)

References 24 publications

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“…The costs from our own institution reflected more accurately the estimates for the cost measurements compared to reimbursement amounts and Medicare allowance costs . Additionally, we demonstrated the utility of using a mathematical model to answer a complex question in medicine. Given that many new treatments are expensive in today's competitive health care environment, we believe that these types of models (i.e.…”

Section: Discussionmentioning

confidence: 78%

An economic analysis of different treatments for bleeding in patients with acquired haemophilia

et al. 2019

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Background Acquired haemophilia A (AHA), with potentially high risk of morbidity and mortality, occurs as a result of inhibitors against factor VIII. Bleeding due to AHA can be treated with activated prothrombin complex concentrate (aPCC), recombinant activated factor VII (rFVIIa) or recently, recombinant porcine-sequence factor VIII (rpFVIII). We extended our previous cost-effectiveness analysis (CEA) comparing rpFVIII against the available traditional options.Methods For high-titred, haemorrhaging AHA patients treated with either aPCC, rFVIIa or rpFVIII, over the course of 6-days, a Markov simulation was conducted to evaluate the outcomes when these patients transitioned into any of the four following health states: (1) continuous bleeding, (2) thrombosis, (3) stop bleeding and (4) death, with states (2), (3) and (4) modelled as absorbing states. All model parameters were obtained from the medical literature, except the costs of aPCC, rFVIIa and the factor VIII assay, which came from our institutional data.Results Excluding the cost of the initial treatment on day 0, the total subsequent treatment cost of rFVIIa was substantially more than the costs of aPCC and rpFVIII ($13 925 vs. $1778 vs. $6957, respectively). The average quality-adjusted life days (QALDs) gained from rpFVIII was lowest (4Á89 vs. 4Á9 for rFVIIa and 4Á91 for aPCC). Overall, aPCC dominated the other two treatments. The model was determined to be robust across the tested ranges for all input variables. ConclusionBased on this economic model, for AHA patients with high titres who were bleeding, aPCC was the most cost-effective treatment option and may be considered for use if there is no clinical contraindication.

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Section: Discussionmentioning

confidence: 78%

An economic analysis of different treatments for bleeding in patients with acquired haemophilia

et al. 2019

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“…Specifically, we used the costs from our own institution in the model, which reflected better estimates for the cost measurements than the usual reimbursement or Medicare allowance costs that were used in other studies. We further demonstrated the utility of using mathematical models to approach a complex problem in the healthcare setting, and in today's healthcare environment, these models with economic outcomes will be increasingly important for treatment decisions and reimbursements, especially in a complex field such as Transfusion Medicine and Hemostasis/Thrombosis .…”

Section: Discussionmentioning

confidence: 99%

aPCC vs. rFVIIa for the treatment of bleeding in patients with acquired haemophilia – a cost‐effectiveness model

Kim

Simmons²,

Bui³

et al. 2018

Vox Sanguinis

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Background Acquired haemophilia A (AHA) is an autoimmune bleeding disorder with significant morbidity and mortality. Bleeding AHA patients with high titre inhibitors can be treated with either activated prothrombin complex concentrate (aPCC) or recombinant activated factor VII (rFVIIa). Given that both replacement therapies have inherent benefits and limitations, a cost‐effectiveness analysis (CEA) was performed in this population to compare rFVIIa with aPCC. Methods In high‐titered AHA patients with bleeding treated with either aPCC or rFVIIa, during a 5‐day study period, a Markov model was developed such that these patients were transitioned into four different health states: (1) continuous bleeding, (2) thrombosis, (3) stop bleeding and (4) death, with states (2), (3) and (4) modelled as absorbing states. Model parameters, including probabilities, health utility index and costs, were gathered from the medical literature, except for the costs of aPCC and rFVIIa, which were obtained from our institutional data. Results During the 5‐day period, the total treatment cost of rFVIIa was substantially more than the cost of aPCC ($13 635 vs. $1741). The average quality‐adjusted life days (QALDs) gained for rFVIIa were slightly lower compared to aPCC (4·08 vs. 4·09). Overall, aPCC prevailed over rFVIIa. Sensitivity analysis confirmed the robustness of the model across tested ranges of all input variables. Conclusion In high‐titered AHA patients with bleeding, aPCC is a cost‐effective treatment option when compared to rFVIIa. Thus, aPCC may be considered in these patients, if available, and provided there is no clinical contraindication.

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“…These findings emphasize the importance of having an experienced TMA diagnostic and management team for the care of these patients. In today's healthcare environment, CEA will become an important part of the medical decision‐making process . In addition to investigating the issue utilizing a rigorous mathematical modeling with proper sensitivity analysis, the major strength of our study is the utilization of data and costs from multiple studies in the literature, as well as our own institutional costs.…”

Section: Discussionmentioning

confidence: 99%

“…In today's healthcare environment, CEA will become an important part of the medical decision-making process. 27,28,[30][31][32][33] In addition to investigating the issue utilizing a rigorous mathematical modeling with proper sensitivity analysis, the major strength of our study is the utilization of data and costs from multiple studies in the literature, as well as our own institutional costs. We further demonstrate the utility of such modeling approaches to complex medical-decision making.…”

Section: Discussionmentioning

confidence: 99%

ADAMTS13 test and/or PLASMIC clinical score in management of acquired thrombotic thrombocytopenic purpura: a cost‐effective analysis

et al. 2017

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Background ADAMTS13 test distinguishes thrombotic thrombocytopenic purpura (TTP) from other thrombotic microangiopathies (TMAs). PLASMIC score helps determine the pretest probability of ADAMTS13 deficiency. Due to inherent limitations of both tests, and potential adverse effects and cost of unnecessary treatments, we performed a cost-effectiveness analysis (CEA) investigating the benefits of incorporating an in-hospital ADAMTS13 test and/or PLASMIC score into our clinical practice. Methods A CEA model was created to compare 4 scenarios for a patient with TMAs, utilizing either an in-house vs. send-out ADAMTS13 assay with or without prior risk stratification using PLASMIC scoring. Model parameters, including probabilities and costs, were gathered from the medical literature, except for the ADAMTS13 send-out and in-house tests, which were obtained from our institutional data. Results If only the cost is considered, in-house ADAMTS13 test for patients with intermediate-high risk PLASMIC score is the least expensive option ($4,732/patient). If effectiveness is assessed as measured by the number of averted deaths, send-out ADAMTS13 test is the most effective. Considering the cost/effectiveness ratio, the in-house ADAMTS13 test in patients with intermediate-high risk PLASMIC score is the best option, followed by the in-house ADAMTS13 test without the PLASMIC score. Conclusions In patients with clinical presentations of TMAs, having an in-hospital ADAMTS13 test to promptly establish the diagnosis of TTP appears to be cost-effective. Utilizing the PLASMIC score increases the cost-effectiveness of the in-house ADAMTS13 test. Our findings indicate the benefit of having a rapid and reliable in-house ADAMTS13 test, especially in the tertiary medical center.

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Plasma Transfusion Demystified: A Review of the Key Factors Influencing the Response to Plasma Transfusion

Cited by 18 publications

References 24 publications

An economic analysis of different treatments for bleeding in patients with acquired haemophilia

An economic analysis of different treatments for bleeding in patients with acquired haemophilia

aPCC vs. rFVIIa for the treatment of bleeding in patients with acquired haemophilia – a cost‐effectiveness model

ADAMTS13 test and/or PLASMIC clinical score in management of acquired thrombotic thrombocytopenic purpura: a cost‐effective analysis

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