Assessing the total costs of blood delivery to hospital oncology and hematology patients
Department of Haematological Oncology, St. Bartholomew's Hospital (Queen Mary University of London), London, UK. Current Medical Research and Opinion
(Impact Factor: 2.65).
11/2006; 22(10):1903-9. DOI: 10.1185/030079906X132532
To determine direct costs associated with a blood transfusion session in two hospital settings.
The study was conducted in two United Kingdom hospital sites during April 2004. Transfusion sessions for patients receiving units of red blood cells within either haematology or oncology departments were followed using time and motion techniques to measure the direct costs. Other data were collected from the centres to calculate the cost of disposables, blood wastage and blood bank machines.
Total mean staff cost per transfusion of 2 units was 37.24 pounds sterling (9.68 pounds sterling for blood bank and 27.56 pounds sterling for ward procedures). The mean cost of disposables was 13.25 pounds sterling and the mean cost for blood products was 287.56 pounds sterling. The mean cost of wastage was 11.86 pounds sterling per transfusion. After including other derived costs, such as hospital stay, the mean cost for a transfusion of 2 units of blood was estimated to be 546.12 pounds sterling.
This study estimates the cost of an average blood transfusion of 2 units to be 546.12 pounds sterling. It should be noted that significant indirect costs, such as those incurred by patients, their carers and societal costs, have not been considered. Against the background of finite blood resources and other factors such as patient quality of life, blood transfusion may not represent the best choice for patient care. Alternative treatments should be considered.
Available from: Sam Salek
- "To identify cost savings in the treatment of chemotherapy-induced anemia associated with Hb level at the time of DA initiation, the risk difference in RBC transfusion rates (based on that identified in the systematic review of clinical studies) was multiplied by the identified average of RBC transfusion cost in Europe (based on the systematic review of economic studies). Among the retrieved clinical studies, only one reported the actual number of units transfused (3.5 units) , while 2 units have been reported as an average number of units typically transfused [26, 27]. Cost savings were, therefore, calculated based on transfusion of 2 and 3.5 units of RBC. "
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Erythropoiesis-stimulating agents can reduce red blood cell transfusion rates in patients developing anemia while receiving chemotherapy. We investigated potential cost savings from reduced transfusion rates in patients starting darbepoetin alfa (DA) at higher versus lower hemoglobin (Hb) levels.
Two systematic literature reviews were performed: transfusion outcomes in patients receiving DA stratified by baseline Hb level and costs of transfusion in Europe. Potential cost savings were calculated by multiplying the difference in transfusion rates between Hb levels by the midpoint of transfusion costs.
Despite differences in baseline characteristics, treatment duration and analysis technique, the clinical studies (n = 8) showed that fewer transfusions were required when DA was initiated at higher versus lower Hb levels. The economic studies (n = 9) showed that 1 unit of transfusion ranged from €130 to €537 (2010-adjusted values). Cost savings from initiating DA at higher versus lower Hb levels were €503–2,226 (2 units transfused) and €880–3,895 (3.5 units) per ten patients.
Transfusion incidence increases with DA initiation at lower Hb levels. Potential cost savings depend on the number of units transfused and cost items included. DA initiation according to guidelines can reduce transfusions and potentially reduce transfusion-associated costs.
Available from: Philippe Massin
- "Blood transfusion costs include the time spent by nurses to check compatibility and to administer the transfusion and the cost of storing and transporting the RBC units (546.12 British pounds for two units in a 2006 study by Agrawal et al.  "
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ABSTRACT: Studies assessing fibrin sealants use during total knee replacement (TKR) have produced inconsistent results. We evaluated fibrin sealant therapy in TKR procedures performed without tourniquet and without postoperative drains.
Use of a fibrin sealant during TKR decreases calculated total blood loss, thereby diminishing blood transfusion requirements and costs.
We studied 62 patients with primary knee osteoarthritis who underwent TKR by the same surgeon between September 2009 and December 2010. Fibrin sealant was used only in the last 31 patients, who were compared to the first 31 patients regarding calculated total blood loss, blood transfusion rate, and mean number of red-blood-cell units used per patient. Costs were compared in the two groups.
In the control group, mean total blood loss calculated using the method of Gross was 1.3±0.6 L, 48% of patients required blood transfusions, and the mean number of units per patient was 0.9±1. In the fibrin-sealant group, 29% of patients required blood transfusions and the mean number of units was 0.6±0.9. The between-group differences in favour of the fibrin-sealant group were not statistically significant. In each group, compared with patients not requiring blood transfusions, patients needing transfusions had significantly lower starting preoperative haemoglobin values and a significantly greater positive difference between the calculated total blood loss and the maximum allowable blood loss. In the test group, the cost of the 31 units of fibrin sealant was 9743€ and the cost reduction due to using 11 fewer red-blood-cell units was only 3484€. Hospital stay was not significantly shorter in any of the two groups.
Blood transfusion minimisation during TKR should rely chiefly on correcting preoperative anaemia and optimizing transfusion decisions based on the difference between the total blood loss and the maximum allowable blood loss. Fibrin sealant did not significantly diminish transfusion requirements in our study. Randomised studies in larger patient populations are needed. The cost of fibrin sealant may exceed the expected cost savings in relation with decreased blood transfusion requirements.
Level III (before-after therapeutic study).
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ABSTRACT: Objetivos: Llevar a cabo una revisión de la literatura sobre el coste de la transfusión sanguínea en España. Se evaluó información de otros países con el fin de comparar las tendencias en los costes.
Métodos: Se realizó una búsqueda electrónica en dos bases de datos: PubMed y Ediciones DOYMA. Ante la escasa evidencia para España, se realizó una búsqueda manual en revistas especializadas. El horizonte de búsqueda fue desde el año 2002 al 2007. Veintiséis publicaciones cumplieron los criterios de inclusión: 6 artículos para España, 6 para Estados Unidos, 5 para Reino Unido, 2 para Francia y 1 para Suecia, Noruega, Holanda, Bélgica, Grecia y Canadá. Se incluyó dentro del estudio una revisión de la literatura sobre el coste del concentrado de hematíes (CH) para el Reino Unido, Estados Unidos y Canadá.
Resultados: De la revisión para España se estimó que el coste de un CH ha aumentado en un 52,8% de 2001 a 2003; considerando el coste de transfundir un CH el coste aumenta un 29,9% (2003–2006). En comparación con otros países, el coste de un CH en los Estados Unidos ha aumentado un 11,73% (2001–2003). En el Reino Unido ha aumentado un 34,11% (2002–2005), y en Francia ha aumentado un 9,05% (2000–2003).
Conclusión: La utilización de una moneda común (€) y los precios constantes al año 2007 permiten realizar una fácil comparación en el tiempo y entre países. El coste de un CH en España se estimó en 150 € por unidad de CH y en 350 € por concentrado transfundido.
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