Platelet outdates Kathryn Webert Medical Director, Utilization, Canadian Blood Services NAC Meeting, October 15, 2015

Summary of Presentation Trend in platelet outdates within Canadian (excluding Quebec) blood system International platelet outdate rates What can we do? Hospital customer survey CBS distribution/production site survey Other suggestions…

Platelet outdates within Canadian* blood system *excluding Quebec

Platelet inventory challenges at CBS and hospitals Platelet outdates within Canadian blood system Platelet inventory challenges at CBS and hospitals Due to 5 day shelf-life, shortages may occur, particularly on 30-day weekends, holidays, winter storms and uneven collections/production Increased collection and production to avoid shortages Geographically remote hospitals There has been a slight yet steady decline in Canadian demand for blood products as health-care systems adopt more efficient approaches to utilization, and blood conservation and surgical techniques. At the same time, we must keep pace with emerging expectations about how blood products are selected and deployed – for example, the increased demand from hospitals for platelets that have undergone HLA (human leukocyte antigen) typing. The diminishing need for many fresh blood components is in contrast to the growing demand for specialized plasma products. We have seen an average annual increase of 6.5 per cent in use of the latter over the past several years, despite new utilization measures introduced by some provincial health ministries. Of particular concern is the growing off-label use of these expensive products, sometimes in the absence of compelling medical evidence that they support effective treatment. The resulting pressure on our traditional sources of supply has obliged us to begin evaluating alternatives Present US/UK numbers:

Platelet inventory challenges at CBS Platelet outdates within Canadian blood system Platelet inventory challenges at CBS Within the Canadian blood system (excluding the province of Quebec), the rate of platelet outdates in the most recent fiscal year (14/15) were: Apheresis platelet units: 24% (7% at CBS, 17% at hospitals) Whole blood-derived platelet doses: 34% (13% at CBS, 21% at hospitals) Financial costs: In the most recent fiscal year, platelet outdates accounted for an approximate cost of $9.8 million to the Canadian healthcare system There has been a slight yet steady decline in Canadian demand for blood products as health-care systems adopt more efficient approaches to utilization, and blood conservation and surgical techniques. At the same time, we must keep pace with emerging expectations about how blood products are selected and deployed – for example, the increased demand from hospitals for platelets that have undergone HLA (human leukocyte antigen) typing. The diminishing need for many fresh blood components is in contrast to the growing demand for specialized plasma products. We have seen an average annual increase of 6.5 per cent in use of the latter over the past several years, despite new utilization measures introduced by some provincial health ministries. Of particular concern is the growing off-label use of these expensive products, sometimes in the absence of compelling medical evidence that they support effective treatment. The resulting pressure on our traditional sources of supply has obliged us to begin evaluating alternatives Present US/UK numbers:

International platelet outdate rates

Benchmarking with other countries International platelet outdate rates Benchmarking with other countries Canada’s platelet outdate rate is higher than many other international blood systems. Other countries (with similar challenges) have chosen to focus on it and have significantly lower rates of platelet outdate Example: Comparative country System outdate rates buffy coat platelets: 14% apheresis platelets: 2.3% There has been a slight yet steady decline in Canadian demand for blood products as health-care systems adopt more efficient approaches to utilization, and blood conservation and surgical techniques. At the same time, we must keep pace with emerging expectations about how blood products are selected and deployed – for example, the increased demand from hospitals for platelets that have undergone HLA (human leukocyte antigen) typing. The diminishing need for many fresh blood components is in contrast to the growing demand for specialized plasma products. We have seen an average annual increase of 6.5 per cent in use of the latter over the past several years, despite new utilization measures introduced by some provincial health ministries. Of particular concern is the growing off-label use of these expensive products, sometimes in the absence of compelling medical evidence that they support effective treatment. The resulting pressure on our traditional sources of supply has obliged us to begin evaluating alternatives Present US/UK numbers:

What can we do?

What can we do? Management of platelet inventory is a complicated topic, but working together within the blood system, we may be able to identify ways to decrease the number of platelet units that are collected but ultimately wasted. Effective stewardship of the blood supply includes utilization management. Utilization management of blood and blood components refers to the promotion of the safe and best use of blood components and associated resources. A broad definition of utilization management would refer to all blood and blood components, including plasma protein products, throughout the supply chain. For example, utilization management includes, among others, appropriate inventory management, the monitoring of wastage of blood products due to outdating or mishandling, and ensuring that blood products are used for appropriate indications at the correct dose. You could also argue that appropriate utilization of blood products also includes patient blood management.

Survey of Hospital Customers What can we do? Survey of Hospital Customers Looking for hospitals’ valuable insights: Identification of factors that may contribute to the outdating of platelet units within the Canadian blood system (in the hospital and throughout the system including CBS production and distribution sites) Sharing of hospital best practices that have been implemented to avoid or decrease the platelet outdate rate Targeted the top 50 hospitals (by platelet volume) HLS contacted hospital blood bank and collected information by interview in most cases

Survey of Hospital Customers What can we do? Survey of Hospital Customers Information gathered included: Delivery information Policies for ordering/stocking platelets Redistribution programs Policies for transfusing of platelets (e.g., group specific, trauma packs, neonates, etc.) Impressions of reasons why platelets outdate Best practices used to prevent outdating Suggestions for improvement (CBS, provincial blood offices, etc.)

Survey of Hospital Customers What can we do? Survey of Hospital Customers Once we have collected this information, it will be shared with all hospital customers Best practices Will be used to inform future initiatives

Survey of CBS Production and Distribution Sites What can we do? Survey of CBS Production and Distribution Sites We are also conducting and internal survey to better understand how the process of platelet procurement and distribution is undertaken nationally and regionally Is there variability in what CBS does in each region? Are there areas for improvement? Survey developed by Ahmed Coovadia, being administered to CBS Regional Production Managers

Survey of CBS Production and Distribution Sites What can we do? Survey of CBS Production and Distribution Sites Information being collected: Platelet collection (whole blood and apheresis) What process is in place to meet hospital demand for platelets? Production What is the process to determine platelet product to meet hospital needs Distribution How are hospital requests met? Redistribution between sites Other Processes in place to minimize wastage

Conclusions and Discussion

Conclusions Conclusions Platelet outdates are a significant problem within the Canadian blood system Due to the nature of the product (short shelf-life) and Canadian geography, outdates are not completely avoidable; however, it is thought that Canada’s numbers could be lower This would result in cost-savings to the healthcare system What else can be done? Suggestions/input on how to proceed welcome… Working group?