{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T04:29:22Z","timestamp":1765254562354,"version":"3.46.0"},"reference-count":27,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Platelet transfusion is critical in managing major bleeding, but access to liquid-stored platelets is limited by their 5- to 7-day shelf life. Cryopreserved platelets last up to 2 years and may improve availability, although their cost-effectiveness remains uncertain.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the cost-effectiveness of cryopreserved platelets vs liquid-stored platelets for managing surgical bleeding.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n An economic evaluation was conducted from the Australian government funder perspective alongside the CLIP-II randomized clinical trial, following intention-to-treat principles. Adult patients (age \u226518 years) undergoing cardiac surgery at 11 Australian tertiary hospitals between August 2021 and April 2024 were screened for eligibility. Eligible patients were those at high risk for platelet transfusion, identified by risk prediction score or clinician judgment, excluding female patients aged 18 to 55 years who were rhesus D (RhD) negative or with unknown RhD status and patients with coagulopathy or prior thromboembolism. Data were analyzed between January and April 2025.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Participants received at least 3 units of either cryopreserved or liquid-stored platelets intraoperatively or within 24 hours postsurgery.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Costs were estimated in 2023 Australian dollars (A$) by assigning unit costs to patient-level resource use in each trial group, including intensive care unit (ICU) admissions, hospitalizations, and blood products. Effectiveness measures included postoperative bleeding volume (first 24 hours post-ICU admission and total), 90-day mortality, type 4 bleeding (based on the Bleeding Academic Research Consortium criteria), and serious adverse events. Given the 90-day follow-up period, discounting was not applied.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 202 participants (median [IQR] age, 66 [57-74] years, 153 [75.7%] male), 104 received cryopreserved platelets and 98 received liquid-stored platelets. The mean difference in per-patient cost was A$15\u202f035 (95% CI, \u2212A$1878 to A$31\u202f949) with cryopreserved platelets vs liquid-stored platelets. Mean blood loss within 24 hours following ICU admission was 121 (95% CI, 5 to 237) mL higher, total postoperative blood loss was 504 (95% CI, 145 to 862) mL higher, and type 4 bleeding was 12.3% (95% CI, 1% to 23.6%) higher with cryopreserved platelets compared with liquid-stored platelets. The difference in 90-day mortality between cryopreserved platelet and liquid-stored platelet groups was not statistically significant (7.4% [95% CI, \u22120.3% to 15.1%]). Only 1 serious adverse event was observed in each group.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this economic evaluation, cryopreserved platelets were dominated by liquid-stored platelets for managing bleeding in cardiac surgery. Further research is needed to assess the potential economic benefits of cryopreserved platelets in broader populations, particularly in regional and remote hospitals where platelet availability is limited.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.54363","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T03:30:23Z","timestamp":1765251023000},"page":"e2554363","source":"Crossref","is-referenced-by-count":0,"title":["Cost-Effectiveness of Cryopreserved vs Liquid-Stored Platelets for Managing Surgical Bleeding"],"prefix":"10.1001","volume":"8","author":[{"given":"Zhomart","family":"Orman","sequence":"first","affiliation":[{"name":"Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael C.","family":"Reade","sequence":"additional","affiliation":[{"name":"Medical School, University of Queensland, Brisbane, Queensland, Australia"},{"name":"Joint Health Command, Australian Defence Force, Canberra, Australian Capital Territory, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denese C.","family":"Marks","sequence":"additional","affiliation":[{"name":"Research and Development, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Belinda D.","family":"Howe","sequence":"additional","affiliation":[{"name":"Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Bailey","sequence":"additional","affiliation":[{"name":"Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alayna","family":"Carrandi","sequence":"additional","affiliation":[{"name":"Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zoe K.","family":"McQuilten","sequence":"additional","affiliation":[{"name":"Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"},{"name":"Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alisa M.","family":"Higgins","sequence":"additional","affiliation":[{"name":"Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"issue":"2","key":"zoi251446r1","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1159\/000499349","article-title":"Microbiological screening of platelet concentrates in Europe.","volume":"46","author":"Prax","year":"2019","journal-title":"Transfus Med Hemother"},{"issue":"1","key":"zoi251446r2","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.tmrv.2019.08.006","article-title":"Is platelet expiring out of date: a systematic review.","volume":"34","author":"Flint","year":"2020","journal-title":"Transfus Med Rev"},{"issue":"7","key":"zoi251446r3","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1056\/NEJM197402142900702","article-title":"Hemostatic effectiveness of liquid-preserved and previously frozen human platelets.","volume":"290","author":"Valeri","year":"1974","journal-title":"N Engl J Med"},{"issue":"1","key":"zoi251446r4","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1080\/09537104.2021.1967917","article-title":"Frozen and cold-stored platelets: reconsidered platelet products.","volume":"33","author":"Jimenez-Marco","year":"2022","journal-title":"Platelets"},{"issue":"4","key":"zoi251446r5","doi-asserted-by":"publisher","first-page":"838","DOI":"10.1111\/trf.12915","article-title":"In vitro comparison of cryopreserved and liquid platelets: potential clinical implications.","volume":"55","author":"Johnson","year":"2015","journal-title":"Transfusion"},{"key":"zoi251446r6","doi-asserted-by":"crossref","DOI":"10.1001\/jama.2025.23355","article-title":"Cryopreserved vs liquid-stored platelets for the treatment of surgical bleeding: the CLIP-II randomized clinical trial.","author":"Reade","year":"2025","journal-title":"JAMA"},{"issue":"1","key":"zoi251446r7","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.jval.2021.11.1351","article-title":"Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations.","volume":"25","author":"Husereau","year":"2022","journal-title":"Value Health"},{"issue":"12","key":"zoi251446r8","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-068933","article-title":"Cryopreserved platelets compared with liquid-stored platelets for the treatment of surgical bleeding: protocol for two multicentre randomised controlled blinded non-inferiority trials (the CLIP-II and CLIPNZ-II trials).","volume":"12","author":"Reade","year":"2022","journal-title":"BMJ Open"},{"issue":"10","key":"zoi251446r10","doi-asserted-by":"publisher","first-page":"2272","DOI":"10.1111\/trf.15990","article-title":"Preoperative identification of cardiac surgery patients at risk of receiving a platelet transfusion: the Australian Cardiac Surgery Platelet Transfusion (ACSEPT) risk prediction tool.","volume":"60","author":"Flint","year":"2020","journal-title":"Transfusion"},{"issue":"7","key":"zoi251446r13","doi-asserted-by":"publisher","first-page":"324","DOI":"10.5694\/mja2.50309","article-title":"The financial cost of intensive care in Australia: a multicentre registry study.","volume":"211","author":"Hicks","year":"2019","journal-title":"Med J Aust"},{"issue":"23","key":"zoi251446r17","doi-asserted-by":"publisher","first-page":"2736","DOI":"10.1161\/CIRCULATIONAHA.110.009449","article-title":"Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium.","volume":"123","author":"Mehran","year":"2011","journal-title":"Circulation"},{"issue":"1","key":"zoi251446r18","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/1472-6963-11-135","article-title":"Impact of bleeding-related complications and\/or blood product transfusions on hospital costs in inpatient surgical patients.","volume":"11","author":"Stokes","year":"2011","journal-title":"BMC Health Serv Res"},{"issue":"9","key":"zoi251446r19","doi-asserted-by":"publisher","first-page":"1966","DOI":"10.1016\/j.clinthera.2015.06.007","article-title":"Cost of bleeding in trauma and complex cardiac surgery.","volume":"37","author":"Zbrozek","year":"2015","journal-title":"Clin Ther"},{"issue":"4","key":"zoi251446r20","doi-asserted-by":"publisher","first-page":"1069","DOI":"10.1016\/j.athoracsur.2019.11.019","article-title":"Bleeding after cardiac surgery is associated with an increase in the total cost of the hospital stay.","volume":"109","author":"Newcomb","year":"2020","journal-title":"Ann Thorac Surg"},{"issue":"3","key":"zoi251446r21","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1016\/j.jtcvs.2009.02.021","article-title":"Costs of excessive postoperative hemorrhage in cardiac surgery.","volume":"138","author":"Christensen","year":"2009","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"1","key":"zoi251446r22","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1186\/s13019-019-0881-3","article-title":"Impact of bleeding complications on length of stay and critical care utilization in cardiac surgery patients in England.","volume":"14","author":"Al-Attar","year":"2019","journal-title":"J Cardiothorac Surg"},{"issue":"4","key":"zoi251446r23","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1111\/vox.12494","article-title":"Effect of storage time of platelet products on clinical outcomes after transfusion: a systematic review and meta-analyses.","volume":"112","author":"Kreuger","year":"2017","journal-title":"Vox Sang"},{"issue":"9","key":"zoi251446r24","doi-asserted-by":"publisher","first-page":"2794","DOI":"10.1111\/trf.15423","article-title":"A randomized, controlled pilot clinical trial of cryopreserved platelets for perioperative surgical bleeding: the CLIP-I trial (Editorial, p. 2759).","volume":"59","author":"Reade","year":"2019","journal-title":"Transfusion"},{"issue":"7","key":"zoi251446r25","doi-asserted-by":"publisher","first-page":"e69","DOI":"10.1111\/vox.12532","article-title":"Vox Sanguinis International Forum on platelet cryopreservation.","volume":"112","author":"Cohn","year":"2017","journal-title":"Vox Sang"},{"issue":"10","key":"zoi251446r26","doi-asserted-by":"publisher","first-page":"2455","DOI":"10.1111\/trf.13778","article-title":"Profiling clinical platelet and plasma use to inform blood supply and contingency planning: PUPPY, the prospective utilization of platelets and plasma study.","volume":"56","author":"Fedele","year":"2016","journal-title":"Transfusion"},{"issue":"1","key":"zoi251446r27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/j.1365-3148.2006.00709.x","article-title":"A survey of the demographics of blood use.","volume":"17","author":"Cobain","year":"2007","journal-title":"Transfus Med"},{"key":"zoi251446r9","unstructured":"Orman? Z, Reade? MC, Marks? DC, . Health economic analysis plan for the CLIP-II trial: Comparing cryopreserved platelets with conventional liquid-stored platelets in the management of surgical bleeding. Accessed December 17, 2024. https:\/\/www.monash.edu\/__data\/assets\/file\/0011\/3808550\/HEAP-CLIP-FINAL-1.1.pdf"},{"key":"zoi251446r11","unstructured":"World Bank. Purchasing power parity conversion factor (GDP) (LCU per international $)\u2014Australia. Accessed November 18, 2025. https:\/\/data.worldbank.org\/indicator\/PA.NUS.PPP?year=2023"},{"key":"zoi251446r12","unstructured":"National Health Service in England. National cost collection for the NHS. Accessed April 15, 2025. https:\/\/www.england.nhs.uk\/costing-in-the-nhs\/national-cost-collection\/"},{"key":"zoi251446r14","unstructured":"Australian Bureau of Statistics. Consumer Price Index, Australia. Accessed October 8, 2024. https:\/\/www.abs.gov.au\/statistics\/economy\/price-indexes-and-inflation\/consumer-price-index-australia\/jun-quarter-2024"},{"key":"zoi251446r15","unstructured":"Independent Health and Aged Care Pricing Authority. National hospital cost data collection: public sector report, 2021-22. Accessed November 21, 2025. https:\/\/www.ihacpa.gov.au\/resources\/national-hospital-cost-data-collection-nhcdc-public-sector-2021-22"},{"key":"zoi251446r16","unstructured":"National Blood Authority. Annual report 2022-23. Accessed November 21, 2025. https:\/\/www.blood.gov.au\/sites\/default\/files\/documents\/nba-annual-report-2022-23.pdf"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2842477\/orman_2025_oi_251446_1764628657.25875.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T03:30:27Z","timestamp":1765251027000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2842477"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,8]]},"references-count":27,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.54363","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,8]]}}}