Background Bleeding is a significant complication in cardiac surgery and is associated with substantial morbidity and mortality. This study evaluated the impact of bleeding on length of stay (LOS) and critical care utilization in a nationwide sample of cardiac surgery patients treated at English hospitals. Methods Retrospective, observational cohort study using linked English Hospital Episode Statistics (HES) and Clinical Practice Research Datalink (CPRD) records for a nationwide sample of patients aged ≥18 years who underwent coronary artery bypass graft (CABG), valve repair/replacement, or aortic operations from January 2010 through February 2016. The primary independent variables were in-hospital bleeding complications and reoperation for bleeding before discharge. Generalized linear models were used to quantify the adjusted mean incremental difference [MID] in post-procedure LOS and critical care days associated with bleeding complications, independent of measured baseline characteristics. Results The study included 7774 cardiac surgery patients (3963 CABG; 2363 valve replacement/repair; 160 aortic procedures; 1288 multiple procedures, primarily CABG+valve). Mean LOS was 10.7d, including a mean of 4.2d in critical care. Incidences of in-hospital bleeding complications and reoperation for bleeding were 6.7 and 0.3%, respectively. Patients with bleeding had longer LOS (MID: 3.1d; p < 0.0001) and spent more days in critical care (MID: 2.4d; p < 0.0001). Reoperation for bleeding was associated with larger increases in LOS (MID = 4.0d; p = 0.002) and days in critical care (MID = 3.2d; p = 0.001). Conclusions Among English cardiac surgery patients, in-hospital bleeding complications were associated with substantial increases in healthcare utilization. Increased use of evidence-based strategies to prevent and manage bleeding may reduce the clinical and economic burden associated with bleeding complications in cardiac surgery. Electronic supplementary material The online version of this article (10.1186/s13019-019-0881-3) contains supplementary material, which is available to authorized users.

Physicians consistently reported high EUQ scores for the fibrin sealant patch across surgical bleeding populations. An important limitation of this study was that the composition of SoC varied across studies and EUQ data were only available for the SoC in two of four trials. Future studies should evaluate ease of use for other hemostats and across other surgical subspecialties, as data are currently limited.

BackgroundDespite hemostat use, uncontrolled surgical bleeding is prevalent. Drawbacks of current hemostats include limitations with efficacy on first attempt and suboptimal ease-of-use. Evarrest® is a novel fibrin sealant patch that has demonstrated high hemostatic efficacy compared with standard of care across bleeding severities. The objective of this study was to conduct a hospital cost analysis of the fibrin sealant patch versus standard of care in soft tissue and hepatic surgical bleeding.MethodsThe analysis quantified the 30-day costs of each comparator from a hospital perspective. Published US unit costs were applied to resource use (ie, initial treatment, retreatment, operating time, hospitalization, transfusion, and ventilator) reported in four trials. A “surgical” analysis included resources clinically related to the hemostatic benefit of the fibrin sealant patch, whereas a “hospital” analysis included all resources reported in the trials. An exploratory subgroup analysis focused solely on coagulopathic patients defined by abnormal blood test results.ResultsThe surgical analysis predicted cost savings of $54 per patient with the fibrin sealant patch compared with standard of care (net cost impact: −$54 per patient; sensitivity range: −$1,320 to $1,213). The hospital analysis predicted further cost savings with the fibrin sealant patch (net cost impact of −$2,846 per patient; sensitivity range: −$1,483 to −$5,575). Subgroup analyses suggest that the fibrin sealant patch may provide dramatic cost savings in the coagulopathic subgroup of $3,233 (surgical) and $9,287 (hospital) per patient. Results were most sensitive to operating time and product units.ConclusionIn soft tissue and hepatic problematic surgical bleeding, the fibrin sealant patch may result in important hospital cost savings.

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unheated CO2 (U-CO2) in laparoscopic patients. Efficacy data were derived from a published randomised controlled trial reporting on the proportion of patients with hypothermia, a US database analysis of hypothermia patients for open surgery, and from an unpublished UK NHS before and after study of laparoscopic surgery patients. Other parameter inputs were obtained from published literature. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of results. Scenario analyses were undertaken to explore structural uncertainty within the model. Results: The use of WH-CO2 dominated standard care, as it was both cost saving and generated greater QALYs, for both open and laparoscopic surgery patients over a one year time horizon. Results varied by the number of patients undergoing surgery per humidifier per year. Based on 250 patients using the humidifier each year over a five year lifetime of the humidifier, WH-CO2 dominated no insufflation in open surgery patients in 71% of model iterations and dominated U-CO2 in laparoscopic surgery in 98% of model iterations. WH-CO2 remained the cost-effective treatment option at a willingness-to-pay threshold of £20,000 per QALY throughout all scenario and sensitivity analyses considered, provided 10 or more patients used each humidifier over its life span. ConClusions: The analyses conducted suggest that based upon the currently available clinical evidence, WH-CO2 is a cost-effective use of resources for patients undergoing either open or laparoscopic colorectal surgery within the UK NHS.

Objectives: Personalized medicine has become standard of care in directing treatment with tyrosine kinase inhibitors in locally advanced or metastatic NSCLC patients, but various testing methods for identifying EGFR mutations exist. We compared the clinical outcomes and budget impact of using the FDA-approved cobas ® EGFR Mutation Test versus Sanger sequencing for identifying EGFR mutations in locally advanced or metastatic NSCLC patients from a US payer perspective. MethOds: A decision-tree model was developed to compare testing methodologies and resulting treatment pathways in a hypothetical NSCLC US population health plan with 5 million covered lives and a baseline EGFR mutation prevalence of 16.6%. Model inputs included parameters describing mutation testing accuracy treatment response (EGFR inhibitor, standard chemo therapy or best supportive care). Inputs were based on published literature and Medicare fee schedule reimbursement. Outcomes of the model included patients with test failures (based on detection limits of testing), average patient survival time and budget impact. Results: Patients whose samples were tested with the cobas® EGFR Mutation Test were less likely to experience test failures due to unusable tissue samples compared to Sanger sequencing (6 test failures versus 57, respectively). Patients using the cobas® EGFR mutations testing received more appropriate care compared to Sanger sequencing (90% vs 82%, respectively), resulting in an average total survival increase of 0.6 months. Costs associated with diagnostic testing were $24,562 less than testing with Sanger sequencing, resulting in similar overall costs per member per month ($0.56). cOnclusiOns: Performing EGFR mutation testing with the cobas® EGFR Mutation Test has advantages from both patient outcomes and payer budget impact perspectives. By correctly identifying more patients for proper treatment with less test failures, the cobas® EGFR Mutation Test is a costeffective strategy for identification of EGFR mutations in locally advanced or metastatic NSCLC patients from a US payer perspective.Objectives: Approximately 7,000 Canadians have multiple myeloma (MM). Without effective treatment, patients can suffer from a constellation of disease-related symptoms that significantly reduce quality of life and survival. Management of stem cell transplant (SCT) ineligible MM patients is complex and varied. Maintenance therapies (MTs) after various induction regimens have been shown to improve response rate and progression-free survival. We sought to compare Canadian costs between two common approaches to MT, either bortezomib or lenalidomide, in MM patients ineligible for SCT. MethOds: The total annual drug cost of the two MT options were calculated and compared. Costs were based on 1.3mg/m 2 of bortezomib on days 1, 4, 8, 11 every three months, plus 50 mg of prednisone every other day, or 10 mg of lenalidomide on days 1 through 21 of each 28-day cycle. Administration costs including oncology nursing time and pharmacist workload, and pharmacy co...

for sensitivity analyses showed cost-savings ranging from € 22,525 to € 996,384 of prophylaxis with aPCC vs. on-demand with rFVIIa. ConClusions: Three times/ week aPCC prophylaxis could reduce 16% the total treatment cost of severe HA with inhibitor, saving up to € 98,000/patient/year.

Purpose Obesity is a growing global issue with evidence linking it to an increase in loss of disease-free years, reduced quality of life, increased mortality, and additional economic burden. This study sought to establish the cost-effectiveness of gastric bypass and sleeve gastrectomy, compared to conventional therapy in patients with obesity, from a Tunisian healthcare payor perspective. Patients and Methods A Markov model compared lifetime costs and outcomes of bariatric surgery with conventional treatment among patients with body mass index (BMI) ≥ 40 kg/m 2 , BMI ≥ 35 kg/m 2 with obesity-related co-morbidities (Group 1), or BMI ≥ 35 kg/m 2 with type 2 diabetes mellitus (T2DM) (Group 2). Inputs were sourced from the Tunisian Health Examination Survey, local clinician data and literature sources. Health states were associated with different cost and utility decrements. Changes in body mass index, systolic blood pressure, lipid ratio and diabetes remission rates were modelled on a yearly basis. The incremental cost-effectiveness ratio (ICER), quality-adjusted life years (QALYs) and net monetary benefit (NMB) were key outcomes. Sensitivity and scenario analyses were performed to test the model’s robustness. Results The model showed that the benefits of bariatric surgery were favorable compared to conventional treatment, with an ICER of 1844 TND/QALY in Group 1 patients and 2413 TND/QALY in Group 2 patients. Bariatric surgery resulted in a QALY gain of 3.26 per patient in Group 1 and a gain of 1.77 per patient in Group 2. At a willingness to pay threshold of 31,379 TND/QALY, the incremental NMB was 96,251 TND and 51,123 TND for Group 1 and Group 2, respectively. Conclusion From the Tunisian healthcare payor perspective, bariatric surgery is cost-effective for patients with obesity and those with T2DM and obesity-related comorbidities. These findings may have impact on future decision-making on funding and reimbursement of bariatric surgery in Tunisia.