Economics of Blood Transfusion
Lead Researchers: Helen Campbell & Sarah Wordsworth
HERC has a portfolio of research in the area of blood transfusion with several large projects evaluating transfusion policies across a range of specialities including cardiac surgery, intensive care, haematological malignancies, and upper gastrointestinal bleeding.
Since the first transfusion of human blood by Dr James Blundell in 1818, the science of transfusion has advanced rapidly. Whilst recently much work has been concerned with safety screening and treatment of blood during its processing, far less research had focussed upon the effective and appropriate use of blood products in routine clinical practice. As blood is a scarce and costly resource, and is associated with benefits as well as risks for the patient, assessing the cost-effectiveness of alternative transfusion policies is paramount.
Amongst the studies HERC is currently involved with is the UK arm of the Age of Blood Evaluation Study (ABLE), run by Professor Tim Walsh at the Royal Infirmary of Edinburgh and funded by the NIHR Health Technology Assessment Programme. ABLE is an international trial comparing fresher versus standard issue red blood cells in critically ill patients. It is anticipated that transfusing fresher blood (less than seven days old) may be more effective and cost-effective than standard issue blood (stored for an average of 18 to 21 days) which is thought to have reduced oxygen carrying capabilities and increased pro-inflammatory properties leading to adverse clinical outcomes for patients.
The trauma-induced coagulopathy programme of work being carried out in collaboration with Professor Karim Brohi at the Royal London Hospital and Dr Simon Stanworth at NHS Blood and Transplant/John Radcliffe Hospital in Oxford is funded through an NIHR Applied Research Programme grant. The programme has a number of aims, including the estimation of the national costs associated with massive transfusion in trauma patients, and modelling the cost-effectiveness of a new bedside test for rapid identification of trauma patients with blood clotting abnormalities (coagulopathy).
The TITRe2 multi-centre trial, being conducted in collaboration with Professors Gavin Murphy at the University of Leicester and Barney Reeves at the University of Bristol, is funded by the NIHR Health Technology Assessment programme and aims to evaluate the effectiveness and cost-effectiveness of the use of lower (restrictive) versus higher (liberal) haemoglobin levels to ‘trigger’ the administration of a transfusion in patients following cardiac surgery. It is anticipated, that as shown in other medical fields, the use of a more restrictive threshold may reduce complications and blood use, without any adverse implications for patients.
Together these studies and the others which make up HERC’s portfolio of research in the field of blood transfusion are generating evidence to help inform cost-effective blood transfusion in routine clinical practice.