blood inflation karen l. dallas, m.d.c.m. tmr journal club may 4, 2010
TRANSCRIPT
Blood InflationBlood Inflation
Karen L. Dallas, M.D.C.M.TMR Journal Club
May 4, 2010
“Activity-Based Costs of Blood Transfusions in Surgical
Patients at Four Hospitals”~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Transfusion April 2010. Vol 50(4), 753-765.
About me…About me…
American (from Minnesota!)McGill Medical SchoolU of T – Hematopathology ResidencyBloodCenter of Wisconsin Fellowship in
Transfusion/Coagulation + Research
…then back to Canada!
ObjectivesObjectives
Why this article?
Relevant background information
Article Review
Critical Appraisal
Discussion (the “meat & potatoes” of this JC!)
Why? Why? (at least (at least somesome of it!) of it!)
>14 million units collected annually in US>1 million in Canada
Previous cost estimates ~$300-700 US Studies/methods imperfect at best
Economic decision-making is increasingly important
Canadian SituationCanadian Situation
1994 – Mean cost per unit RBC transfused in Canada was reported at $152.17 US
CBS/HQ paper (Transfusion, 2004) re-visited issue:
Total $264.81 US Collection, production, distribution = $202.74 Donor time = $18.21 Hospital processing = $16.65 Actual transfusion = $26.92 Acute reaction management = $0.29
Accounting 101Accounting 101
Costing a.k.a. Cost Accounting type of accounting process which aims to
capture costs of production most beneficial as a tool for management in
budgeting and setting up cost control programs
Traditional CostingVS.
Activity-Based Costing (ABC)
Entire 136-page OCCI Guide…
0 entries for transfusion or blood!!
MethodsMethods
Main Processes in Transfusion ChainMain Processes in Transfusion Chain
Flow Diagram (YIKES!)
Formulas… Formulas… (YIKES!)(YIKES!)
Costs of Acquisition and Costs per Unit
Are the results valid? In this case, I think we can safely say, “Yes!”
What are the results? These results show the cost of blood – in US and
European settings alike – to be much higher than previously reported. They also demonstrate the amount of “overhead”cost inherent to hemotherapy.
How can we apply the results to patient care? This is the subject of our discussion…
DiscussionDiscussionA few starter questions…A few starter questions…
Is ABC worthwhile? Idea of LEAN Accounting…
Should we re-visit the cost of Blood Center Production?
What are we to do with this information? Blood conservation, blood alternatives, etc. Transfusion is life-saving…are all “costs”
created equally?
Thank-you!Thank-you!
Dr. Skeate
andCBS Medical Office, Toronto
Dr. Fernandes, U of T Hematopathology