Nancy M. Heddle

Background The CONvalescent Plasma for Hospitalized Adults With COVID‐19 Respiratory Illness (CONCOR‐1) trial was a multicenter randomized controlled trial assessing convalescent plasma in hospitalized COVID‐19 patients. This study evaluates the cost‐effectiveness of convalescent plasma and its impact on quality‐of‐life to provide insight into its potential as an alternative treatment in resource‐constrained settings. Methods Individual patient data on health outcomes and resource utilization from the CONCOR‐1 trial were used to conduct the analysis from the Canadian public payer's perspective with a time horizon of 30 days post‐randomization. Baseline and 30‐day EQ‐5D‐5L were measured to calculate quality‐adjusted survival. All costs are presented in 2021 Canadian dollars. The base case assessed the EQ‐5D‐5L scores of hospitalized inpatients reporting at both timepoints, and a utility score of 0 was assigned for patients who died within 30 days. Costs for all patients enrolled were used. The sensitivity analysis utilizes EQ‐5D‐5L scores from the same population but only uses costs from this population. Results 940 patients were randomized: 627 received CCP and 313 received standard care. The total costs were $28,716 (standard deviation, $25,380) and $24,258 ($22,939) for the convalescent plasma and standard care arms respectively. EQ‐5D‐5L scores were 0.61 in both arms ( p = .85) at baseline. At 30 days, EQ‐5D‐5L scores were 0.63 and 0.64 for patients in the convalescent plasma and standard care arms, respectively ( p = .46). The incremental cost was $4458 and the incremental quality‐adjusted life day was −0.078. Discussion Convalescent plasma was less effective and more costly than standard care in treating hospitalized COVID‐19.

Background and Objectives Debate exists surrounding the optimal duration of red blood cell (RBC) storage. A hypothesis emerging from previous research suggests that exposure to fresh blood may be harmful to patients undergoing cardiac surgery. This study uses a large transfusion medicine database to explore the association between in‐hospital mortality and red cell storage duration. Materials and Methods This is an exploratory retrospective cohort study of all adult patients at Hamilton, Canada, over a 14‐year period that received at least one allogeneic red cell transfusion during their hospitalization for cardiac surgery requiring bypass. The primary outcome for the study was in‐hospital death. Analysis was performed using multivariate Cox regression modelling with time‐dependent and time‐independent covariates and stratification variables. Five models with varying definitions for short, intermediate and prolonged duration of RBC storage were tested. Results From March 2004 to December 2017, 11,205 patients met the inclusion criteria and were included in the regression analyses. No significant effect of short‐duration red storage on patient mortality was observed in all statistical models, with the red cells stored for the longest duration as the reference group. When patients who received exclusively fresh (hazard ratio [HR] 1.040, 95% confidence interval [CI] 0.588–1.841, p ‐value = 0.893) and older aged (HR 1.038, 95% CI 0.769–1.1.402, p ‐value = 0.0801) RBCs were compared with those who received exclusively mid‐age red cells as the reference, statistical significance was similarly not reached. Conclusion Red cells stored for the shortest duration are not associated with increased risk of mortality among cardiac surgery patients.