CBS Transfusable Products Update NAC Meeting April 2012 Rick Trifunov Director, Plasma Products and Services NAC November 2009

Presentation Overview Transfusable Products Update Distribution Data System Outdates Red Cells Platelets Pathogen Reduction Update NAC November 2009

Transfusable Products Distribution Trends

In the first 3 Q’s of F11/12, Demand for RBC is trended back to longer term growth patterns Anecdotal feedback received of strong first two quarters for traumas and increased transfusion triggers in cardiac surgery

Positive growth in 6/9 Provinces Cindy, Jennifer – any thoughts as to why? NAC November 2009

O Neg RBC trending upwards first 3Q’s of the year O Neg RBC trending upwards first 3Q’s of the year. O Neg inventories have been drawn down in Q4 and orders cut We have been cutting inventories by 10% over last few weeks, to protect inventory. NAC November 2009

NL, PEI & NS showing largest growth over previous year NAC November 2009

CMV Neg % running flat

Frozen Plasma demand continues to decline however we are starting to see a slow down

Sizeable shifts in 4 Provinces. Data anomaly or shifts in practice? Wassup with NS? Reductions driven by appropriate use vs. new PPPs? NAC November 2009

The % of plasma orders for AB is growing Note: CAGR over the last seven years is -2% for plasma but is 0% for AB plasma

Several Provinces seeing large shifts in the % of AB plasma ordered versus previous fiscal Seeing some jumps. NAC November 2009

Strong platelet growth in the first two quarters of 11/12 Anecdotal feedback attributes growth to increased use of “platelet drugs” such as Plavix, and continued decentralization of oncology care resulting in more sites inventorying platelets NAC November 2009

Sizeable platelet demand growth in some Provinces MB – what’s driving? NAC November 2009

Demand for CMV Negative Platelets as a % of all platelet orders remains around 34 – 35%

Is NAC still considering recommending a “25% cap” on CMV Neg Supply Order fill rate = 98%, so most are getting what they order. CMV virus is filtered out with white cells Testing for cmv costs money. Most of Atlantic showing significantly different usage patterns than the rest of Canada, NAC November 2009

CBS to start development work for pooled cryo in 2012/13. The strong growth seen last year for Cryo has continued in the first 3 Q’s of the year Anecdotal feedback of greater use in massive hemorrhage protocols 10 x 10ml doses req’d to give a decent Fibrinogen dose. If we start to pool cryo, what dose would they expect? AB and BC will want this regardless of PPP Fibrinogen concentrate. CBS to start development work for pooled cryo in 2012/13. What specification would NAC members expect in the final pooled product (Fibrinogen content)? NAC November 2009

Large rise in Cryo demand in New Brunswick - ? New treatment protocols 149.2% Large rise in Cryo demand in New Brunswick - ? New treatment protocols Need to understand why for NB? NAC November 2009

Per capita demand for Cryo in NB nearing that of NL & NS

System Outdate Reports Red Cells & Platelets

Data Limitations The outdate data displayed in the following slides is sourced from two data systems. There are limitations to both data sets CBS MAK Progesa System A CBS site can supply multiple provinces, e.g. Halifax ships product to NS & PEI hospitals so CBS Halifax outdates apply to two provinces Hospital Disposition System Not all hospitals report so data can be months/quarters behind (see next slide) There is no reconciliation to ensure 100% of issued products are accounted for

Data Limitations BC outdates not available for December 2011 Majority of Manitoba hospital data has not been reported since April 2010 CDHA data is not included for Nova Scotia due to problems with data extract from their IT system

Chart Options Two suggestions for reports have been suggested; Report outdate rates as a percentage of units issued Report outdates per 1,000 population

RBC Outdate Rates as a percent of issues Outdate spikes tend to be linked to periods of high inventory, e.g. Jan to March 2010, pandemic inventory build. Charts could be prepared as monthly trend charts. These can be broken by Province however see limitations on slide 29

Platelet Outdate Rates as a percent of issues

Red Cell Outdates per 1,000 Population Charts could also be provided as provincial comparators If all provinces and territories were to be separated out we would need to assign CBS outdates to jurisdictions based on share Our low CBS outdates might be because we can ship to some hospitals when near end date. NAC November 2009

Platelet Outdates per 1,000 Population

Chart Preferences Display outdates as a rate of issues or per 1,000 population? Monthly trend charts vs. Multiple province view? Best way to assign CBS Outdates? Any other chart suggestions? Note: Permission to share hospital outdate data outside of NAC needs to be obtained by PT’s Don’t start sharing them outside of NAC. NAC November 2009