The continued decline of plasma transfusions in Taiwan: An 11-year population-based study.

BACKGROUND AND OBJECTIVES: In Taiwan, plasma use per capita ranks among the highest in the world. We aimed to describe the trends in usage after the introduction of new hospital accreditation standards that evaluate compliance with institutional plasma transfusion guidelines. MATERIALS AND METHODS: We identified hospitalizations receiving plasma between 2007 and 2017 from the national health insurance database. We estimated plasma transfusions per thousand capita. The risk ratio of transfusion rates among hospitalizations in 2017 compared to 2007 was estimated using logistic regression. RESULTS: The total number of plasma transfusions declined from 964,408 in 2007 to 659,828 in 2017, yielding a rate of 28.00 per thousand capita. The proportion of hospitalizations receiving plasma declined by 38%, from 3.89% (95% confidence interval: 3.86%-3.91%) to 2.62% (2.61%-2.64%). Gastroenterology (16.4%) and general surgery (15.3%) accounted for the largest proportions of plasma usage. Within these two services, liver diseases were the top diagnoses needing plasma use. For hospitalized patients with liver diseases, approximately 40% of plasma units were administered to patients with neither noticeable bleeding nor red blood cells transfusions. Among these patients, almost 50% received plasma with an international normalized ratio trigger of less than 1.50. The use of potential alternative therapies or anticoagulants remained quite low during this period. CONCLUSION: Plasma utilization rates during hospitalizations continuously declined over 11 years. However, inappropriate plasma use remained high, while the use of alternative therapies remained low in services such as gastroenterology. To improve the appropriateness of plasma transfusions, patient blood management should be implemented in the near future.

Clinical use of intravenous immunoglobulin in Taiwan: A 10-year population study.

Intravenous immunoglobulin (IVIG) is used in the treatment of immunological, inflammatory and neurological conditions. We aimed to describe the trends in IVIG utilization in Taiwan. We identified patients receiving IVIG through the national health insurance (NHI) database. We described the distribution of IVIG use according to main indications. During 2008-2017, IVIG distribution grew 10% per year on average. The population IVIG dose was 8.0 g per thousand capita. Among the total distribution, approximately 60% were NHI-reimbursed. Pediatrics (52.3%), rheumatology (14.0%) and hematology/oncology (11.4%) accounted for the top three services in terms of IVIG consumption. Primary and secondary immune deficiency (29.8%), Kawasaki disease (20.5%) and thrombocytopenia (16.8%) were the top three indications. Neurological conditions only accounted for 3%. In brief, unlike countries with high population use, the proportion of reimbursed IVIG used for neurological conditions was low. Further studies on self-paid IVIG use is needed to completely understand utilization in Taiwan.