Transfusion-Related Cost Comparison of Trauma Patients Receiving Whole Blood Versus Component Therapy.

INTRODUCTION: With the emergence of whole blood in trauma resuscitation, cost-related comparisons are of significant importance to providers, blood banks, and hospital systems throughout the country. The objective of this study is to determine if there is a transfusion-related cost difference between trauma patients that received low titer O+ whole blood (LTO + WB) and component therapy (CT).

METHODS: Retrospective review of adult and pediatric trauma patients who received either LTO + WB or CT from time of injury to within 4 hours of arrival. Annual mean cost per unit of blood product were obtained from the regional blood bank supplier. Pediatric and adult patients were analyzed separately and were compared on a cost per patient (cost/patient) and cost per patient per milliliter (cost/patient/mL) basis. Subgroup analysis was performed on severely injured adult patients (ISS > 15) and patients that underwent massive transfusion (MT).

RESULTS: Prehospital LTO + WB transfusion began at this institution in January 2018. After the initiation of the whole blood transfusion the mean annual cost decreased 17.3% for all blood products and the average net difference in cost related to component blood products and LTO + WB was over $927,000. In adults, LTO + WB was associated with a significantly lower cost/patient and cost/patient/mL compared to CT at 4-hours, (p < 0.001), at 24 hours (p < 0.001), and overall (p < 0.001). In the severely injured subgroup (ISS > 15), WB was associated with a lower cost/patient and cost/patient/mL at 4-hours (p < 0.001), 24 hours (p < 0.001), and overall (p < 0.001), with no difference in the prehospital setting. Similar findings were true in patients meeting MT criteria, although differences in injury severity may account for this finding.

CONCLUSION: With increased use of LTO + WB for resuscitation, cost comparison is of significant importance to all stakeholders. LTO + WB was associated with reduced cost in severely injured patients. Ongoing analyses may improve resource utilization and benefit overall healthcare cost.Level of Evidence: Therapeutic/Care Management, IV.