Cost-effectiveness

Abstract

BACKGROUND:

The increasing costs, limited supply, and clinical risks associated with allogeneic blood transfusion have prompted investigation into autologous blood management strategies, such as postoperative red blood cell (RBC) salvage. This study provides a cost comparison of transfusing washed postoperatively salvaged RBCs using an orthopedic perioperative autotransfusion device (OrthoPat, Haemonetics Corporation) versus unwashed shed blood and banked allogeneic blood.

STUDY DESIGN AND METHODS:

Abstract

OBJECTIVE:

We sought to identify risk factors for central line-associated bloodstream infection (CLABSI) to describe children who might benefit from adjunctive interventions.

DESIGN:

Case-control study of children admitted to the medical-surgical intensive care unit (ICU) or cardiac ICU from January 1, 2004, through December 31, 2007.

SETTING:

Children's Hospital Boston is a freestanding, 396-bed quaternary care pediatric hospital with a 29-bed medical-surgical ICU and a 24-bed cardiac ICU.

PATIENTS:

Summary This UK study looked at the direct in-hospital cost of delivering red blood cell (RBC) transfusion to hematology and oncology patients. Excluding indirect costs such as costs to patients, carers and society and the cost of transfusion adverse events, these investigators calculated a mean direct in-hospital cost of £546.12 (USD $1,020.17; exchange rate as of 18 October 2006) per 2 unit RBC transfusion. The study was conducted in two UK hospitals, one a university teaching hospital and the other a district general hospital.

Summary Using data from the blunt trauma arm of the Boffard et al randomized controlled trial and supplemental data from United Kingdom trials, Morris et al constructed a model for assessing the life-time cost-effectiveness of recombinant factor VIIa (rFVIIa) relative to placebo in bleeding blunt trauma patient for the United Kingdom (UK).

Summary [Waters and coworkers conducted a comprehensive economic analysis of the autologous cell salvage program at Cleveland Clinic Foundation to calculate a per unit cost that could be compared with the procurement cost of a unit of allogeneic blood. They concluded that, in their institution, cell salvage was significantly less expensive than allogeneic blood. Cost assessment encompassed the total cost of their cell salvage program. Initial capital outlay for setting up the program included the purchase of machines and disposables, the training of technicians and training materials.

Summary This manuscript by Shander et al represents ongoing work by the Society for the Advancement of Blood Management (SABM) using process-cost analysis to estimate the total societal cost of blood (COBCON I).

Summary In 2007, the national coverage determination (NCD) issued changes for erythropoiesis-stimulating agents (ESAs) that urge Medicare and private payers to evaluate their policies for use of ESA injectables. The Center for Medicare and Medicaid Services (CMS) has not yet issued a request for change to the NCD decision. Crisafulli outlines the important components of the policy as it pertains to the treatment of anemia secondary to myelosuppressive anticancer chemotherapy in patients with solid tumors, multiple myeloma, lymphoma, and lymphocytic leukemia.

Summary Although cost-effective donor deferral and blood product screening programs have decreased the risks of transfusion-related infections and new methods of testing hold promise for further reductions, these come with considerable extra costs in relation to the benefits they offer. A single donation of nucleic acid testing of donor blood for HIV, HCV, and HBV has been estimated to cost up to $11.2 million per quality adjusted life-year (QALY) gained.

Abstract

BACKGROUND:

Anemia is associated with higher morbidity and mortality in patients with heart failure (HF), but its implications for heath care costs are not well described.

METHODS AND RESULTS:

Abstract

BACKGROUND:

Blood utilization has long been suspected to consume more health care resources than previously reported. Incomplete accounting for blood costs has the potential to misdirect programmatic decision making by health care systems. Determining the cost of supplying patients with blood transfusions requires an in-depth examination of the complex array of activities surrounding the decision to transfuse.

STUDY DESIGN AND METHODS: