Health economics of Patient Blood Management: a cost‐benefit analysis based on a meta‐analysis

Abstract

Background and Objectives Patient Blood Management (PBM) is the timely application of evidence‐based medical and surgical concepts designed to improve haemoglobin concentration, optimize haemostasis and minimize blood loss in an effort to improve patient outcomes. The focus of this cost‐benefit analysis is to analyse the economic benefit of widespread implementation of a multimodal PBM programme. Materials and Methods Based on a recent meta‐analysis including 17 studies (>235 000 patients) comparing PBM with control care and data from the University Hospital Frankfurt, a cost‐benefit analysis was performed. Outcome data were red blood cell (RBC) transfusion rate, number of transfused RBC units, and length of hospital stay (LOS). Costs were considered for the following three PBM interventions as examples: anaemia management including therapy of iron deficiency, use of cell salvage and tranexamic acid. For sensitivity analysis, a Monte Carlo simulation was performed. Results Iron supplementation was applied in 3·1%, cell salvage in 65% and tranexamic acid in 89% of the PBM patients. In total, applying these three PBM interventions costs €129·04 per patient. However, PBM was associated with a reduction in transfusion rate, transfused RBC units per patient, and LOS which yielded to mean savings of €150·64 per patient. Thus, the overall benefit of PBM implementation was €21·60 per patient. In the Monte Carlo simulation, the cost savings on the outcome side exceeded the PBM costs in approximately 2/3 of all repetitions and the total benefit was €1 878 000 in 100·000 simulated patients. Conclusion Resources to implement a multimodal PBM concept optimizing patient care and safety can be cost‐effectively.

Validation of the BATT score for prehospital risk stratification of traumatic haemorrhagic death: usefulness for tranexamic acid treatment criteria

“…This clear criterion could improve prehospital administration of TXA by paramedics. Although the use of this threshold would increase the number of patients treated, TXA is safe and inexpensive and is likely to be highly cost-effective [ 29 , 30 ]. Randomised trials of TXA in trauma and surgery have included over 50,000 patients and no increase in vascular occlusive events has been found [ 4 , 17 , 31 – 33 ].…”

Validation of the BATT score for prehospital risk stratification of traumatic haemorrhagic death: Usefulness for tranexamic acid treatment criteria.

“…Although the use of this threshold would increase the number of patients treated, TXA is safe and inexpensive and is likely to be highly cost-effective. [26,27] Randomised trials of TXA in trauma and surgery have included over 50,000…”

Blood management during the COVID-19 pandemic

“…To achieve optimal patient outcomes, PBM implements a variety of treatment strategies to minimize or reduce the use of blood products as well as decrease overall healthcare costs. [4][5][6][7] The practice and standards of PBM are universal across specialties as well as inpatient, outpatient, surgical, and medical disciplines.…”