Towards evidence-based PBM: systematic reviews to scientifically underpin the appropriate use of platelets

Organisation: Centre for Evidence-Based Practice of the Belgian Red Cross

Project duration: 01.2021 – 12.2023 (Finalised)

Grant amount: EUR 30,000

Project description: Patient Blood Management is an evidence-based, multidisciplinary approach to caring for patients who might need a blood transfusion. Platelets are the second most commonly transfused cellular blood component, and is mainly indicated to treat or prevent bleeding in patients with thrombocytopenia or platelet function disorder. The increased demand and limited supply of platelet products show that judicious use of platelet transfusions is crucial.

Project Aims:

1. 1. To identify the best available evidence regarding the cost-effectiveness of different methods used during preparation, storage, selection and dosing of platelets for transfusion (systematic review)
   2. To identify the best available evidence regarding the cost-effectiveness of thrombopoietin mimetics as alternatives to first-line or second-line treatment modalities in adult patients with thrombocytopenia (systematic review)

Outcomes:

1. The scoping review identified 110 systematic reviews (search date: 5 May 2021), mapped in interactive evidence maps according to clinical context and concept. Several areas, for example, platelet transfusion in intracerebral haemorrhage and the ratio of blood products in massive transfusion and viscoelastic testing to guide platelet transfusion, are served by multiple overlapping systematic reviews. The scoping review is published in Vox Sanguinis and can be accessed here: Systematic reviews on platelet transfusions: Is there unnecessary duplication of effort? A scoping review (cebap.org)
2. The systematic review on the cost-effectiveness of different platelet preparation, storage, selection and dosing methods in platelet transfusion identified 15 full economic evaluations (search date: 19 October 2021). Eight evaluations investigated the costs and health consequences of pathogen reduction technology and found an incremental cost per QALY varying from EUR 260K to EUR 36M. Evidence was sparse for other methods, such as pathogen testing/culturing, use of apheresis instead of whole blood-derived platelets, and storage in platelet additive solution. The manuscript is published in PharmacoEconomics Open and can be accessed here: https://link.springer.com/article/10.1007/s41669-023-00427-w
3. The systematic review on the cost-effectiveness of thrombopoietin mimetics identified 18 economic evaluations from nine different countries (search date: 29 November 2021). The cost-effectiveness of TPO mimetics in adult patients with thrombocytopenia ranged from a dominant strategy to a significant incremental cost per QALY/health outcome or a clinically inferior strategy with increased costs. The manuscript is published in PharmacoEconomics Open and can be accessed here: https://link.springer.com/article/10.1007/s40273-023-01271-w

Related resources: 

Links to interactive evidence maps of the scoping review:

• https://www.cebap.org/storage/cebap/20220110-eppimap-studydesign.html
• https://www.cebap.org/storage/cebap/20220110-eppimap-age.html
• https://www.cebap.org/storage/cebap/20220714-eppimap-outdatedness.html

Knowledge dissemination of our scoping review during the meeting of the Scientific Working Group European Hematology Association:

• https://www.cebap.org/knowledge-dissemination/conferences-and-meetings/
• https://www.linkedin.com/feed/update/urn:li:activity:6976969963110596608