Cost‐effectiveness of using recombinant activated factor VII as an off‐label rescue treatment for critical bleeding requiring massive transfusion

Ho, Kwok M.; Litton, Edward

doi:10.1111/j.1537-2995.2011.03505.x

Cited by 11 publications

(14 citation statements)

References 27 publications

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“…Cost‐effectiveness analysis has also shown significant incremental cost associated with rfVIIa use in massive transfusion. (Ho & Litton, ) These considerations led the Canadian National Advisory Committee on Blood Products to recommend against use of rfVIIa in non‐haemophilic bleeding (Lin et al , ). rfVIIa has subsequently been removed from the hospital MTP.…”

Section: Discussionmentioning

confidence: 99%

Not only in trauma patients: hospital‐wide implementation of a massive transfusion protocol

Kreuziger

Morton

Subramanian

et al. 2013

Transfusion Medicine

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Objectives To review outcomes of massive transfusion protocol (MTP) activation and determine the impact of MTP implementation on blood bank use. Background MTP has been established to rapidly provide plasma and packed red blood cells in ratios approaching 1:1. Due to availability, MTP has been utilized in non-traumatic hemorrhage despite evidence of benefit in this population. Our hospital wide implementation of MTP was reviewed for propriety, outcomes, and effect on blood bank resources. Methods Retrospective cohort study of patients receiving transfusion after MTP activation from October 2009- 2011. Underlying medical conditions and baseline medication use were determined. In-hospital and 24-hour mortality were compared with evaluation for confounding by APACHE score and duration of MTP activation. Blood product use before and after MTP implementation was reviewed. Results MTP activation occurred in 62 trauma and 63 non-trauma patients. Non-trauma patients were older, had more underlying medical conditions, and higher APACHE scores compared to trauma patients. 24-hour mortality was higher in trauma compared to non-trauma patients (27.4% vs. 11.1%, p =0.02). There was no significant difference of in-hospital mortality. Transfusion ratio did not differ between trauma and non-trauma patients and was not associated with mortality even when MTP activation duration and APACHE score were considered. Hospital-wide blood product use did not change with MTP implementation. Conclusions MTP may be successfully used in trauma and non-trauma settings without significantly impacting overall blood product utilization. Inclusion of non-trauma patients into prospective studies of resuscitation with blood products is warranted to ensure benefit in these patients.

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Section: Discussionmentioning

confidence: 99%

Not only in trauma patients: hospital‐wide implementation of a massive transfusion protocol

Kreuziger

Morton

Subramanian

et al. 2013

Transfusion Medicine

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“…education program would be even more cost-effective. Second, the cost-effectiveness of this program compared favorably with some widely accepted preventive programs such as screening for breast cancer - evaluated at $24,000 per life year gained [17] - and also life-saving medical interventions for patients with major trauma [18,19]. …”

Section: Discussionmentioning

confidence: 99%

An injury awareness education program on outcomes of juvenile justice offenders in Western Australia: an economic analysis

Geelhoed

Gope

et al. 2012

BMC Health Serv Res

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BackgroundInjury is a major cause of mortality and morbidity of young people and the cost-effectiveness of many injury prevention programs remains uncertain. This study aimed to analyze the costs and benefits of an injury awareness education program, the P.A.R.T.Y. (Prevent Alcohol and Risk-related Trauma in Youth) program, for juvenile justice offenders in Western Australia.MethodsCosts and benefits analysis based on effectiveness data from a linked-data cohort study on 225 juvenile justice offenders who were referred to the education program and 3434 who were not referred to the program between 2006 and 2011.ResultsDuring the study period, there were 8869 hospitalizations and 113 deaths due to violence or traffic-related injuries among those aged between 14 and 21 in Western Australia. The mean length of hospital stay was 4.6 days, a total of 320 patients (3.6%) needed an intensive care admission with an average length of stay of 6 days. The annual cost saved due to serious injury was $3,765 and the annual net cost of running this program was $33,735. The estimated cost per offence prevented, cost per serious injury avoided, and cost per undiscounted and discounted life year gained were $3,124, $42,169, $8,268 and $17,910, respectively. Increasing the frequency of the program from once per month to once per week would increase its cost-effectiveness substantially.ConclusionsThe P.A.R.T.Y. injury education program involving real-life trauma scenarios was cost-effective in reducing subsequent risk of committing violence or traffic-related offences, injuries, and death for juvenile justice offenders in Western Australia.

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“…13,14 Kwok et al, evaluated rFVIIa in critically ill patients and found that while use as part of a massive transfusion order set inferred a high cost, it did not translate into an overall survival benefit. 15 It is reasonable to conclude that judicious use of factor product in critically ill or trauma patients with active hemorrhage is recommended, but ideal factor candidates have not been a concluded from the literature.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of a Pharmacy-Led Blood Factor Stewardship Program

Trueg

Lowe²,

Kiel³

2017

American Journal of Therapeutics

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To report the results of a pharmacist-directed blood factor stewardship program targeting off-label utilization designed to limit use to established organizational guidelines in high-risk populations. Prospective evaluation of recombinant factor VIIa and prothrombin complex concentrate orders beginning June 2013 through May 2014 and a matched retrospective cohort from June 2012 to May 2013. Matched cohorts were evaluated for 28-day mortality, change in international normalized ratio (INR), adverse events, concurrent blood product use, and cost savings. Forty-two orders for blood factor were ordered between June 2013 and May 2014, 70 orders in the year before (N = 112). Twenty eight–day mortality was not different between the cohorts: 53.9% versus 50% (P = 0.77). Blood factor use with underlying liver failure and active bleeding was strongly associated with 28-day mortality: odds ratio (95% confidence interval), 2.9 (1.5–7.14) and 2.91 (0.01–2.91), respectively. Blood products dispensed increased over the year with plasma products the most significant (1 vs. 4 P = 0.004). All other clinical outcomes were nonsignificant. An annual cost savings of $375,539 was achieved, primarily through a significant reduction in recombinant factor VIIa and avoidance in high-risk patients. Use of off-label blood factors can be controlled through a pharmacist-led stewardship program. Twenty eight–day mortality was not different between the 2 cohorts; however, identification of risk factors for death associated with blood factor use allows for restriction in high-risk populations, creates a discussion of futile care, and yields cost savings.

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Cost‐effectiveness of using recombinant activated factor VII as an off‐label rescue treatment for critical bleeding requiring massive transfusion

Abstract: As a lifesaving treatment for critical bleeding, the incremental cost of rFVIIa was high. Careful patient selection is critical to balance the potential benefits of rFVIIa in an individual patient against the cost to the community.

Cited by 11 publications

References 27 publications

Not only in trauma patients: hospital‐wide implementation of a massive transfusion protocol

Not only in trauma patients: hospital‐wide implementation of a massive transfusion protocol

An injury awareness education program on outcomes of juvenile justice offenders in Western Australia: an economic analysis

Clinical Outcomes of a Pharmacy-Led Blood Factor Stewardship Program

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