Modelling the outcomes of different red blood cell transfusion strategies for the treatment of traumatic haemorrhage in the prehospital setting in the United Kingdom

BACKGROUND AND OBJECTIVES: The limited supply and increasing demand of group O RhD‐negative red blood cells (RBCs) have resulted in other transfusion strategies being explored by blood services that carry potential risks but may still provide an overall benefit to patients. Our aim was to analyse the potential economic benefits of prehospital transfusion (PHT) against no PHT. MATERIALS AND METHODS: The impact of three PHT strategies (RhD‐negative RBC, RhD‐positive RBC and no transfusion) on quality‐adjusted‐life‐years (QALYs) of all United Kingdom trauma patients in a given year and the subset of patients considered most at risk (RhD‐negative females <50 years old), was modelled. RESULTS: For the entire cohort and the subset of patients, transfusing RhD‐negative RBCs generated the most QALYs (141,899 and 2977, respectively), followed by the RhD‐positive RBCs (141,879.8 and 2958.8 respectively), and no prehospital RBCs (119,285 and 2503 respectively). The QALY difference between RhD‐negative and RhD‐positive policies was smaller (19.2, both cohorts) than RhD‐positive and no RBCs policies in QALYs term (22,600 all cohort, 470 for a subset), indicating that harms from transfusing RhD‐positive RBCs are lower than harms associated with no RBC transfusion. A survival increase from PHT of 0.02% (entire cohort) and 0.7% (subset cohort) would still make the RhD‐positive strategy better in QALYs terms than no PHT. CONCLUSION: While the use of RhD‐positive RBCs carries risks, the benefits measured in QALYs are higher than if no PHT are administered, even for women of childbearing potential. Group O RhD‐positive RBCs could be considered when there is a national shortage of RhD‐negative RBCs.