NAC Meeting Cheryl Doncaster / Kathryn Webert Utilization November 2017

Agenda Items Reference Documents System Wide Platelet Discards ‘Thawed not used’ Plasma Discards Reference Documents Platelet System Outdate Report 2016-2017 Fresh Component Disposition Trends (including SD Plasma) NEW Hospital Specific PPP Trend Reports

System Wide Platelet Discards

Extended Shelf Life

Utilization Update (post extended shelf life implementation) Hospital response to platelet extended shelf life implementation is varied and not completely known yet. Platelet disposition data from hospitals is now being reported for the month of October 2017. Hospitals are focusing on data monitoring and adjusting standing platelet orders as appropriate. In some cases, the number of deliveries/wk have decreased. # Hospitals that have adjusted standing orders Total platelets removed from standing orders /week 11 34 units

Process Improvement and Redistribution Initiative System Impact Decrease Discards Impact production/ collection plans Decrease Costs Customer/Patient Benefits Extended Shelf Life Yes – 30% Yes (# discarded) No (process costs) Longer shelf life Process Improvement and Redistribution Yes – 60% (including extended shelf life) Yes Yes (redistribution for system and # discarded) Enhanced service HLA / HPA No Optimized process and provision of effective product APLT Reduction Yes (# discarded and process costs) Shift towards less expensive product PAS Yes - Less desirable bld grps will not be thrown out TBD Universal platelets Plasma for fractionation Non-destructive QC Yes - extra plts available Chagas Yes – extra 2000 units available /yr Transport Bag (Hospitals): C4I funded Yes – extra plts available Investment in customer initiative to improve system performance July 26, 2017

Platelet Program Focus Area Initiative Objective Timeframe Platelet Shelf Life Optimization Extended Shelf Life Extend the shelf life of platelets to 7 days Implemented: August 14, 2017 Process Improvement Optimize processes: Inventory management, ordering practices, timing of plt production and release to hospitals Start discovery work: January 2018 Redistribution Leverage logistics routes, do more to assist the system Platelet Apheresis Dependency HLA / HPA Requirements Optimize availability of product for patients, provide demand data to support future reduction in apheresis collections Implemented: July – October 2017 Apheresis Reduction Reduce the system dependency on apheresis platelets Implemented: September 2017 Multi-year slow and controlled effort Platelet Additive Solution (PAS) Universal platelets Approx. 3 years Testing Non –destructive QC Retain units in inventory Production studies scheduled to start: June 2018 Chagas Test at risk donors once, retain units in inventory Minimum 18 months Utilization / Reporting Supportive / Ongoing

Actuals (*incomplete hospital data) Estimates (in progress) Nov 15, 2017 Initiatives Stakeholder Consultation (Q4) Extended Shelf Life (Q2) NAC Recommendations ? Apheresis Reduction (Q2) Distribution / Redistribution Improvements Non- destructive QC PAS Chagas Testing Blood System 2015 - 2016 2016 – 2017 2017 - 2018 2018 - 2019 2019 - 2020 Total plt produced 131, 290 134, 527 132, 471 133, 300 127, 396 Apheresis Pooled 40, 013 91, 277 40, 983 93, 544 35, 000 97, 471 30, 000 103, 300 25, 000 102, 396 Total plt discards 37, 329 36, 105 15, 058* 31, 989 29, 300 19, 396 -outdate discards -in date discards 26, 489 10, 850 24, 810 11, 295 10, 836* 5, 567* 21, 189 (mid yr 30%) 10, 800 18, 500 (full yr. 30 %) 10, 596 (60%) 8, 800 CBS 14, 509 14, 306 7, 354 13, 602 13, 145 9, 801 4, 557 (17%) 9, 952 3, 854 (15.5%) 10, 452 2, 165 5, 189 3, 602 10, 000 3, 145 1, 801 8, 000 Hospitals 22, 830 21, 799 9, 149* 18, 387 16, 155 9, 595 21, 932 (83%) 898 20, 956 (84.5%) 843 8, 771* 378* 17, 587 800 15, 355 8, 795 Transfused 94, 589 98, 823 46, 942* 100, 482 104, 000 108, 000 30, 391 64, 198 31, 234 67, 589 14, 523* 32, 419* Source data: Hospital = BOA0831 CBS = BOR0401 Fiscal 2015-2016 baseline data Grey font Estimate of platelets produced = Transfused (guess) + total discards Total discards = estimated outdate reduction (J. Blake modeling) + indate discards (guess) Estimate of platelets outdated at CBS and Hospitals = total outdate estimate split between both. Hospitals = 83%, CBS = 17% Estimates are conservative and do not take into account full impact of some initiatives. - more work is required to better understand these impacts.

‘Thawed not used’ Plasma

2014 – 2015 = 4, 271 2015 – 2016 = 4, 208 2016 – 2017 = 4, 363 (excludes BC/Y)

Discussion points: Overall, the amount of plasma discarded as ‘thawed not used’ is consistent year to year, however; some jurisdictions are trending down, while others are going up. Are there specific practices influencing this? ‘Thawed not used’ plasma is a specific plasma disposition category. Should the data be combined with ‘outdate’ data (>1 yr) for analysis?

NEW Hospital Specific PPP Disposition Report Excel based 12 month hospital performance metrics 36 month trend graphs for select products Highlight usage trends and cost over time Available to hospitals in December 2017 Online via the ‘Trend Report’ area within the Blood Component and Product Disposition System