Cost-Effectiveness and Economic Boundaries of Low-Titer Group O Whole Blood in Pediatric Trauma

Low-titer group O whole blood (LTOWB) reduces mortality in pediatric trauma when added to component therapy (CT;ie, any protocol based on ratios of isolated blood components). Despite this benefit, no cost-effectiveness analysis has compared the strategies. We built a decision tree comparing LTOWB+CT with CT alone for previously healthy children under 16 requiring massive transfusion. We used a 30-day horizon, a US Level I trauma center perspective, and a willingness to pay threshold of $100,000 per mortality averted. LTOWB+CT averted 2.7 additional deaths per 100 patients and cost $788.32 more per case. The incremental cost-effectiveness ratio was $29,571.17 per mortality averted; LTOWB+CT was cost-effective in 58% of iterations. Cost-effectiveness was lost below a willingness to pay of $25,000, above an LTOWB unit cost of $1,566.18, or more than 5.3 LTOWB or 9.1 packed red cell units. Low-titer group O whole blood is a cost-effective addition to pediatric massive transfusions protocols (MTP), but definable economic limits bind its value.