do we really know what a transfusion costs?oct 13, 2018 · richard kaufman md medical director,...

Do We Really Know What a

Transfusion Costs?

10/13/2018

Faculty Disclosures

The following faculty have no relevant financial relationships to disclose:

– Seema Kacker

The following faculty have a relevant financial relationship:

– Maureane Hoffman MD, PhD

Novo Nordisk: Honoraria

Coagulation Sciences: Consultant

Dova: Consultant

– Aryeh Shander MD

Masimo: Consultant

Merck: Consultant

Baxter: Consultant

AMAG: Consultant

CSL: Consultant

Octpharma: Consultant

Vifor: Consultant

Hbo2 Therap: Consultant

Gauss: Consultant

– Richard Kaufman MD

Dova Pharmaceuticals: Consultant

www.aabb.org 2

Learning Objectives

• Recognize the difficulties involved in estimating the

cost of a course of transfusion therapy

• Summarize activities that contribute to the costs of

transfusion therapy

• Appreciate the utility of accurate estimation of the

true cost of transfusion therapy

www.aabb.org 3

What does a platelet transfusion cost?

Richard Kaufman MDMedical Director, Brigham and Women’s Hospital Transfusion Service

Associate Professor of Pathology, Harvard Medical School

Oct. 13, 2018

Faculty Disclosure(In compliance with ACCME policy, AABB requires the following disclosures to the session audience)

• Consultant, Dova Pharmaceuticals

www.aabb.org 2

Objectives

• Describe how studies of platelet costs have differed from studies of red blood cell costs.

• Compare the costs of different platelet dosing strategies.

• Evaluate factors affecting the cost of pathogen-reduced platelets.

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PLADO

Slichter 2010, NEJM 362:600

1272 pediatric or adult patients receiving Chemo or SCT

Low Medium HighPLT prophylaxis dose:

Grade 2+ bleeding: 71% 69% 70% NS

What does a low-dose PLT transfusion cost?

Approach:• Process mapping

• Time studies

• Cost analysis

www.aabb.org 5Riley 2012, Transfusion 52:1957

PLT transfusion: blood bank workflow

www.aabb.org 6

Lab Tech 1

Lab Tech 2

Lab Tech 3

Riley 2012, Transfusion 52:1957

PLT transfusion: patient care unit workflow

www.aabb.org 7

Unit coordinator

Nurse 1

Nurse 2


Steps to transfuse one platelet unit

Location Steps(n)

Time/unit(minutes)

Blood Bank 23 20.3

Patient care unit 23 36.5

TOTAL: 46 56.8


Steps to transfuse one platelet unit

Location Steps(n)

Time/unit(minutes)

Adjusted time/unit (minutes)

Blood Bank 23 20.3 32.3

Patient care unit 23 36.5 58.4

TOTAL: 46 56.8 90.7


Cost estimates: low/medium/high-dose PLTs

www.aabb.org 10

Category Low Medium High

aPLT units/transfusion 0.5 1 2

Transfusions/patient (n) 16 12 8

Total nonproduct cost/transfusion $86.49 $81.54 $96.82

Total PLT cost/transfusion $195.00 $390.00 $780.00

Total cost/transfusion $281.49 $471.54 $876.82

Total cost/patient $4503.77 $5658.48 $7014.59


Product acquisition cost is the biggest contributor to platelet transfusion cost

www.aabb.org 11

Category Low Medium High

Total PLT cost/transfusion 69% 83% 89%

Total nonproduct cost/transfusion 31% 17% 11%


What do pathogen-reduced PLTs cost?

If PR were implemented at BWH, what current costs could be eliminated?

Inpatient PLT transfusions at BWH

n = 8,400/year

64

18

153

BMT/Onc

Surg

Med

Other5,376/year

Potential off-set #1: bacterial testing

$175,000/year

Potential off-set #2: irradiation

$120,000/year

Potential off-set #3: PLT outdating

5-day PLTs

3.5% wastage

350 units/year

7-day PLTs

1% wastage

100 units/year

$70,000/year

Potential off-set #4: CMV testing

Total (potential) off-sets at BWH

+

= $365,000/year

+

Potential future off-sets

New tests for:

• Dengue

• Chikungunya

• SARS

• Etc.

Would implementing pathogen reduction increase PLT transfusions?

Riboflavin-UV Control Treated p

Recovery (%) 66.5 ± 13.4 50.0 ± 18.9

PLADO

Slichter 2010, NEJM 362:600


Low Medium HighPLT prophylaxis dose:

Grade 2+ bleeding: 71% 69% 70%

Median PLT doses/pt: 5 33 P < 0.001

NS

SPRINT

McCullough 2004; Blood 104:1534


PR PLTs ControlPLT prophylaxis:

Grade 2+ bleeding: 58.5% 57.5%

Mean PLT doses/pt: 8.4 6.2 P < 0.01

NS

Standard v. PR PLTs: 24 hour CCIAnalysis 1.14. Comparison 1 Pathogen-reduced platelets versus standard platelets, Outcome 14 Lab

response - 24-hour corrected count increment (CCI) [x 103/L].

Review: Pathogen-reduced platelets for the prevention of bleeding

Comparison: 1 Pathogen-reduced plateletsversusstandard platelets

Outcome: 14 Lab response - 24-hour corrected count increment (CCI) [x 103/L]

Study or subgroup PCT Plts Standard PltsMean

Difference WeightMean

Difference

N Mean(SD) N Mean(SD) IV,Fixed,95%CI IV,Fixed,95%CI

1 Intercept pltsvsstandard plts - single platelet transfusion studies

Lozano 2011 92 4.59 (3.52) 94 6.55 (5.21) 24.2 % -1.96 [ -3.24, -0.68 ]

Subtotal (95% CI) 92 94 24.2 % -1.96 [ -3.24, -0.68 ]

Heterogeneity: not applicable

Test for overall effect: Z = 3.01 (P= 0.0026)

2 Intercept pltsvsstandard plts - multiple platelet transfusion studies

Janetzko 2005 22 7.3 (6.2) 21 10.4 (6.5) 2.7 % -3.10 [ -6.90, 0.70 ]

Kerkhoffs2010 85 7.9 (5.3) 99 12.8 (7.8) 10.8 % -4.90 [ -6.81, -2.99 ]

McCullough 2004 318 6.7 (5.63) 327 10.1 (6.11) 47.9 % -3.40 [ -4.31, -2.49 ]

van Rhenen 2003 52 7.33 (5.38) 51 10.56 (7.06) 6.7 % -3.23 [ -5.66, -0.80 ]

Subtotal (95% CI) 477 498 68.2 % -3.61 [ -4.37, -2.85 ]

Heterogeneity: Chi2 = 2.13, df = 3 (P= 0.55); I2 =0.0%

Test for overall effect: Z = 9.31 (P< 0.00001)

3 Mirasol pltsvsstandard plts - multiple platelet transfusion studies

Cazenave 2010 56 5.58 (4.95) 54 7.56 (7) 7.6 % -1.98 [ -4.25, 0.29 ]

Subtotal (95% CI) 56 54 7.6 % -1.98 [ -4.25, 0.29 ]


Test for overall effect: Z = 1.71 (P= 0.088)

Total (95% CI) 625 646 100.0 % -3.09 [ -3.71, -2.46 ]

Heterogeneity: Chi2 = 7.86, df = 5 (P= 0.16); I2 =36%

Test for overall effect: Z = 9.64 (P< 0.00001)

Test for subgroup differences: Chi2 = 5.73, df = 2 (P= 0.06), I2 =65%

-10 -5 0 5 10

Favours standard plts Favours PCT plts

76Pathogen-reduced platelets for the prevention of bleeding (Review)

Copyright © 2013 The Cochrane Collaboration. Published by John W iley & Sons, Ltd.

Butler 2013, Cochrane: CD009072

Favors treated PLTsFavors standard PLTs

PR v. Standard PLTs: transfusions per patient

Analysis 1.15. Comparison 1 Pathogen-reduced platelets versus standard platelets, Outcome 15 Number of

platelet transfusionsper patient per day of platelet support.

Review: Pathogen-reduced platelets for the prevention of bleeding

Comparison: 1 Pathogen-reduced plateletsversusstandard platelets

Outcome: 15 Number of platelet transfusionsper patient per day of platelet support

Study or subgroup PCT Plts Standard PltsMean

Difference WeightMean

Difference

N Mean(SD) N Mean(SD) IV,Fixed,95%CI IV,Fixed,95%CI

1 Intercept pltsvs standard plts - multiple platelet transfusion studies

Janetzko 2005 22 0.7 (0.3) 21 0.8 (0.7) 1.4 % -0.10 [ -0.42, 0.22 ]

McCullough 2004 318 0.74 (0.31) 327 0.65 (0.31) 64.5 % 0.09 [ 0.04, 0.14 ]

Subtotal (95% CI) 340 348 65.9 % 0.09 [ 0.04, 0.13 ]


Test for overall effect: Z = 3.56 (P = 0.00037)

2 Mirasol pltsvs standard plts - multiple platelet transfusion studies

Cazenave 2010 56 0.24 (0.16) 54 0.2 (0.19) 34.1 % 0.04 [ -0.03, 0.11 ]

Subtotal (95% CI) 56 54 34.1 % 0.04 [ -0.03, 0.11 ]



Total (95% CI) 396 402 100.0 % 0.07 [ 0.03, 0.11 ]



Test for subgroup differences: Chi2 = 1.24, df = 1 (P= 0.27), I2 =19%

-0.2 -0.1 0 0.1 0.2

Favours PCT plts Favours standard plts

77Pathogen-reduced platelets for the prevention of bleeding (Review)

Copyright © 2013 The Cochrane Collaboration. Published by John W iley & Sons, Ltd.

Butler 2013, Cochrane: CD009072

Favors standard PLTsFavors treated PLTs

EFFIPAP

www.aabb.org 27

Grade 2+ bleeding: 47.9% 43.5%45.3%

Median PLT doses/pt: 6 5 5

790 patients withbone marrow aplasia

PR PLTs (PAS) Untreated PLTs (PAS) Untreated PLTs (plasma)PLT prophylaxis:

P = 0.001

Garban 2018, JAMA Oncol 4:468

Inpatient PLT transfusions

n = 8,400/year

64

18

153

BMT/Onc

Surg

Med

Other5,376/year

+ ?

Conclusions

• In contrast to RBC transfusions, product costs dominate the cost of PLT transfusion.

• A low-dose PLT strategy could be less expensive, but is logistically unappealing.

• The cost of PR PLT will vary by local cost offsets.

• PR PLTs have reduced CCIs; expect to use more units/patient for prophylaxis.

www.aabb.org 29

Do We Really Know What a

Transfusion Costs?Aryeh Shander, MD, FCCM, FCCP, FASA

Emeritus Chief Department of Anesthesiology, Critical Care and Hyperbaric

Medicine.

Englewood Hospital and Medical Center, Englewood, New Jersey

Adjunct Clinical Professor of Anesthesiology, Medicine and Surgery

Icahn School of Medicine at Mount Sinai, New York

Clinical Professor of Anesthesiology and Critical Care Rutgers Medical School,

New Jersey

Disclosure 1

SPEAKERS BUREAU: Merck

CONSULTANT/SPEAKER: Masimo Corporation, CSL

Behring, AMAG, Gauss Surgical, Vifor Pharma,

Octapharma and Pharmaniaga

GRANT/RESEARCH: CSL Behring, Gauss Surgical,

Masimo, HbO2 Therapeutics, LLC

Disclosure 2

CONSULTANT: USDOD, USDOJ and USDHHS

Overview Cost analysis in healthcare -

Does it matter what the cost of transfusion is?

– Overuse of blood components

– Serious variability in use

– Poor or no improved outcome

What is the cost of RBC transfusion?

COBCON 1 and 2

COBCON 3 – Cost of plasma transfusion

What’s next?

27.2 29.1 31.8 34.6 38.4 41.9 46.1 51.6 58.4 65.9 74.6 82.7 92.7 102.8 116.5 133.3 152.7 173.9 195.3 221.5 255.3 296.2 334.0 367.8

405.0 442.9 474.7 516.5

579.3 644.8

721.4 788.1

854.1 916.6 967.2

1,021.6 1,074.4 1,135.2

1,201.5 1,277.7

1,369.1 1,486.2

1,628.6 1,767.6

1,895.7 2,023.7

2,156.2 2,295.3

2,399.1 2,495.4

2,598.8 2,689.3

2,797.3 2,879.0

3,026.2

3,200.8 3,337.2

0

500

1000

1500

2000

2500

3000

3500

4000D

oll

ar

Am

ou

nt

(Bil

lio

ns)

2016: $3.3 Trillion

($10,348 per person)

17.9% of GDP

Centers for Medicare & Medicaid

National Health Expenditures Continue to Rise

1960: $27 Billion

($146 per person)

5.0% of GDP

Why is this relevant to transfusion?

Transfusion and blood bank services may be seen as a potential source of cost savings

Complex and unpredictable nature of transfusion (clinician activities) lead to inefficiencies and waste

Wide variation in costs and outcomes

Constant push for safer, more efficient, cheaper services

Imbalance between supply and unpredictable demand

A healthcare

resource issue

Types of Economic Evaluation

Outcomes Example

Cost Analysis Costs ($) Lifetime cost of chronic transfusion

for patient with sickle cell disease

Cost Minimization Costs ($) Comparison of cost for hospital to

store emergency blood in operating

rooms or in blood bank

Cost-Effectiveness Costs ($)

Effectiveness

(natural units)

Financial and health impact of

incorporating HIV NAT

Cost-Utility Costs ($)

Utility (QALYs,

DALYs)

Cost-utility analysis of an electronic

medical record check to confirm that

a transfusion is appropriate for a

particular patient

Cost-Benefit Costs ($)

Benefits ($)

Cost-benefit analysis of alternative

blood donation campaigns

Cost? Charge? Price?

Cost: the expense incurred to deliver a service

Charge/price: the amount billed for a service

Reimbursement: payment for a service made to a provider by a third-party

Assuming that these measures are the same may not always be appropriate!

Cost analysis

Key Question: What are the resources being

used?

Barnett et al., Journal of Medical Economics 2018

Janssen et al., Vox Sanguinis 2018

Stokes et al., Transfusion 2018

Shander et al., Transfusion 2010;

Cost analysis – Key Definitions

Costs– Direct medical

– Direct non-medical

– Indirect, productivity-related

– Intangible

Perspective– Patient

– Payer

– Hospital

– Societal

Time frame

– Short-run

– Long-run

▪ Discount rate

B: New Rx may be more harmful and cost more

D: New Rx may decrease health outcomes but cost less

C: New Rx improves health outcomes at lower cost

A: New Rx improves health outcomes at higher cost

C D

Health Outcomes

Medical

Costs

+

+ -

-

A

C

B

D

When is an Intervention Cost-

Effective ?

Economic Analyses

Set of formal, quantitative methods for comparing alternative strategies for care

–Evaluate expected outcomes

–Evaluate relative resource use

–Explicit measurement and valuation of resource consumption or costs

Methods

–Randomized trial (what does happen?)

–Decision analysis (what might happen?)

Types of Analyses

Cost of Illness: The financial burden of a disease is estimated

Cost-Benefit: costs and benefits measured in monetary terms. Can be pronounce if an intervention is worth doing at all

Cost-Minimization: Effects are the same so compare costs

Cost-Effectiveness: Costs in monetary terms and effects in some equivalent term

Cost-Utility: Outcomes are quality-adjusted

Are the Results Valid (Validation) ?

Did it truly determine which strategy

provides the most benefit for the available

resources?

Was it a full economic comparison of

competing strategies?

–This requires comparable cost comparisons and

precise estimates of effectiveness

–Both costs and outcomes for each alternative

must be analyzed

Cost-minimization

Key Question: Which is the least costly option

among these alternatives?

Ellingson et al., Transfusion 2017

Riley et al., Transfusion 2012

Cost-effectiveness

Key Question: How does the extra cost

compare to the extra outcome?

Compare two or more approaches on

both cost (𝐶0, 𝐶1) and effectiveness (𝐸0, 𝐸1)

Incremental cost-effectiveness ratio

(ICER)

𝐼𝐶𝐸𝑅 =𝐶1 − 𝐶0𝐸1 − 𝐸0

Cost-effectiveness

Often useful for assessing the value of new technologies, programs, or policies

Ex: Cost-effectiveness of using prospective antigen-matching to reduce alloimmunization among patients with sickle cell disease

–Costs ($)

–Effectiveness (alloimmunization events)

Kacker et al., Transfusion 2014

Impact of Cost

COST REIMBUSEMENT ACCESS

How many patient would be denied aspect of care needed

To deny one abuse of the system?

How many abuser would be denied for one needing patient?

What is the Perspective ?

Is it broad enough?

–Patient, provider, third-party payer, society

Depends on the question:

–Narrow: using hospital costs in deciding to implement an early discharge program

▪Who bears the costs of complications after discharge?

▪Worthwhile to society may not be to an organization with a bottom line

What is the Perspective ?

Should include patient perspective, and

indirect costs; missed work, transportation,

out-of-pocket expenses

Infrequently done, difficult to track

Can do it by using quality-adjusted

outcomes which factor in most “indirect costs”

8.1% 8.5% 8.5% 8.7% 9.0%9.1% 9.4% 9.9%

10.4%10.5%10.5% 10.7% 11.1% 11.2%

16.0%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

As

Pe

rce

nta

ge

of G

DP

Total Health Expenditure as a Share of GDP,U.S. and Selected Countries, 2008

Source: Organization for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database)

5.7%6.3% 6.5% 6.6%

7.0% 7.2% 7.2% 7.3% 7.4% 7.4% 7.4%7.7% 8.1% 8.1%

8.7%

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

Pe

rce

nta

ge

of G

DP

Public Health Expenditure as a Percentage of GDP, U.S. and Selected Countries, 2008


6.6% 5.7%7.2% 7.2% 6.5% 7.0%

7.7% 7.3% 8.1% 8.1%6.3%

8.7%7.4%

1.5% 2.8%1.3% 1.5% 2.5% 2.1%

1.7% 3.1%2.4% 2.5%

4.4%

2.5%

8.5%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Pe

rce

nta

ge

of G

DP

Public and Private Health Expenditures as a Percentage of GDP,

U.S. and Selected Countries, 2008

PrivateExpenditurePublicExpenditure








COBCON 1 and 2


What’s next?

NATIONAL SUMMIT ON OVERUSE

SEPTEMBER 24, 2012

•Elective PCI•Myringotomy and Tubes•Early C – section•Antimicrobials in URI•Blood transfusion

Transfusion OVERUSE

Reports of 40 – 60% inappropriate RBC transfusions

Using inverse relationship -implementation of any restriction

–Reduction of 12 to 83%

–Reduction of 9 to 77%

–Reduction of 85% FFPWilson k. et. al. TRANSFUSION 2002

Tinmouth A. et.al. Arch Int Med 2005

Sweeney J. et. Al.Transfusion 2011

Isr J Health Policy Res. 2017

Observed Variation in Hospital-Specific Transfusion Rates for Primary Isolated CABG Surgery With Cardiopulmonary

Bypass During 2008 (N = 798 Sites)

Bennett-Guerrero, E. et al. JAMA 2010;304:1568-1575.

• Variation in transfusion rates due to:• Local culture and practice

• Physician preference re: hemoglobin “trigger”

• Variation in transfusion rates not due to

differences in patient acuity • Transfused patients not necessarily that different

than those not transfused

• Some of the variation is due to differences

in how patients’ blood is “managed”:

anemia treatment, avoiding blood loss,

inappropriate transfusion threshold

Using the NBCUS data:

– 21 million blood products transfused in the U.S. annually

– Estimated 6.5 million to 10.5 million transfused unnecessarily

– $1.4 billion to $2.4 billion in waste a year from the cost of the blood alone

– Additional $3.5 billion to $6 billion in waste from the labor to store, test and transfuse

Using the NSQI data:

– Reducing blood usage by 30% could result in a repurposing of 12 million nursing hours, annual reductions of 200,000 wound complications and eight million fewer patient days in the hospital; as many as 50,000 lives could be saved.

Hannon T et al. TWSJ 2015







COBCON 1 and 2


What’s next?

Vox Sang. 2018

13 experts from 9 hospitals - estimate the additional care

required following various types of transfusion reactions

Am J Crit Care. 2018

N = 256,396 adults were hospitalized with sepsis without major bleeding or surgery

at 364 US hospitals

Martin AN et al. J Surg Res. 2016

Causes of 30-d morbidity stratified by transfusion status

Transfused (n = 48) Not transfused

(n = 474)

P value∗ All patients n = 522

Surgical site infection 7 (14.6) 35 (7.4) 0.389 42 (8.1)

Ventilator >48 h 12 (25.0) 8 (1.7)

What is the Average Cost of Transfusing

One Unit of Blood?

Why not just call a blood bank and ask?

Nominal price tag of a unit of

allogeneic blood

“Hidden” costs of blood

Limitations of economic evaluation

Assumptions

May not be applicable to all

contexts

May not capture all relevant

outcomes of interest

May be difficult to compare

Shander et al, Transfusion Med Rev. 2005

Prior attempts may have underestimated

costs associated with transfusions...

Recognizing the limitations, an activity-based approach will

more fully account for the cost of blood than present estimates.

Consensus Conference

Transfusion is a Complicated Process

Many of the

steps incur

additional

costs…


Activity-Based Costing (ABC)


COBCON II

Applying ABC to asses cost of transfusion in surgical populations at Institutional

Level:

– Tasks and resource consumption (materials, labor, third-party services,

capital) related to blood administration were identified prospectively

– Process frequency (i.e. usage) data were captured retrospectively and used

to populate the ABC model

– Two US and two European hospitals:

▪ Englewood Hospital Medical Center (EHMC; New Jersey, USA)

▪ Rhode Island Hospital (RIH; Rhode Island, USA)

▪ Centre Hospitalier Universitaire Vaudois (CHUV; Lausanne, Switzerland)

▪ General Hospital Linz (AKH; Linz, Austria)

TOTAL cost of TRANSFUSION

How much is the total cost of blood transfusion from a societal perspective?

1. Cost incurred to donors?

2. Cost of producing blood components for transfusion?

3. Cost of transfusion logistics and preparation withinhospitals?

4. Cost of administering and monitoring actual transfusion?

5. Cost of treating adverse transfusion outcomes?

6. Cost of treating transfusion transmitted disease?

7. Cost of litigation (claims of contaminated victims)?

8. Cost of lost productivity?

9. Cost of organizing and maintaining nationwide/continental hemovigiliance systems?

Transfusion 2010

0 USD

500 USD

1,000 USD

1,500 USD

2,000 USD

2,500 USD

3,000 USD

3,500 USD

EHMC RIH CHUV AKH LinzMean RBC product cost Mean cost per RBC txn Mean txn cost per surgical pt txed

COBCON - Shander et al., Transfusion 2010

Cost of RBC Transfusion

Trentino K.M et al. Transfusion 2015

89,996 multi-day, acute-care inpatient separations

• the mean inpatient cost was 1.83 times higher in the

transfused group compared with the non-transfused group

(95% confidence interval 1.78 to 1.89; p

What is the Average Cost of A Transfused

Unit of Blood?

$200?

– Total annual cost = $ 2.9 billion

$300?


$500?


$1000?


Each $100 error in estimating the cost of a

single unit of blood means that our total

annual estimate is off by $1.5 billion

Retrospective cohort study of all hospitalisations in

the US in 2004 (n=38.66 million) to assess in-hospital

outcomes associated with blood transfusion.

5.8% (2.33 million) transfused

After adjustment for age, gender, comorbidities,

admission type or DRG transfusion associated with:

▪ 1.7 increased odds of death (P







COBCON 1 and 2


What’s next?

Background and objectives

US FFP usage has significantly increased over the last

decade leading to elevated healthcare costs.

FFP often transfused inappropriately & evidence for its

clinical efficacy is poor

COBCON 3:

– Plasma usage and transfusion costs in a real-world US

inpatient setting

– Determine the cost-effectiveness of FFP vs. various PBM

options to treat coagulopathies

COBCON – Shander et al. Vox Sang 2016

Methodology for COBCON 3

All activities related to plasma transfusion recorded at

a single US hospital over one calendar year

Collected in a stepwise manner using an activity-

based costing (ABC) methodology

This model maps all technical, administrative and

clinical processes inherent to the cost of plasma.


Cost of Plasma Transfusion


Transfusion. 2018

N = 438 data collection forms were completed by 74 staff

The cost of administering blood was $71 (£49) per unit for

RBCs, $84 (£58) for platelets, $55 (£38) for FFP , and $72

(£49) for cryoprecipitate.

Stokes and coworkers provides some information on the discrepancy of

costs across hospitals

Authors conclude that the costs for these two institutions, although

different, are in the same order of magnitude

More useful is to combine their cost estimates with effectiveness

estimates

Stokes deviated from microcosting strategy approach only for overhead

costs, which they estimate at 20% for laboratory inputs, uniform across

activities.

Potentially more precise way to estimate overhead costs is

activity‐based costing

Stokes and colleagues chose an appropriate costing perspective for

their purposes

Cataife G et al. Transfusion. 2018

What’s Next? Set of formal, quantitative methods for

comparing competing strategies

Evaluate expected outcomes

– Evaluate relative resource use

– Explicit measurement and valuation of resource consumption or costs

Methods

–Randomized trial (what does happen?)

–Decision analysis (what might happen?)

–Large clinical data base analysis (what if…)

SUMMARYCost analysis in healthcare -


Overuse of blood components

Serious variability in use

Poor or no improved outcome


COBCON 1 and 2


What’s next?

THANK

YOU

ST1-1 Do We Really Know What a Transfusion CostsKaufman_PLT Cost talkAABB 2018 - Final Do We Really Know What a Transfusion Costs

do we really know what a transfusion costs?oct 13, 2018 · richard kaufman md medical director,...

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