The effect on costs of the use of half-dose aprotinin for first-time reoperative coronary artery bypass patients

Able, Mary E.; Tilly, Darcie A.

doi:10.1016/s0149-2918(98)80067-2

Cited by 8 publications

(2 citation statements)

References 18 publications

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“…To our knowledge, no paper has yet been published that analyzes cost data for transfusion-related cost of aprotinin administration in patients undergoing infectious orthopedic surgery. This is in contrast to corresponding economic studies in cardiac surgery patients [11,12,19,20]. These studies demonstrate aprotinin not only efficacious in reducing blood loss and effective in reducing allogeneic blood transfusion but also to be a cost-effective adjunct pharmacological intervention, especially when low-dose aprotinin is applied [12,19].…”

Section: Discussionmentioning

confidence: 71%

Transfusion-Related Cost of Adjunct Aprotinin Application in One-Step Infected Hip Revision Arthroplasty – Cost-Minimizing Analysis

Singbartl¹,

Kantak²,

Munkel³

2001

Transfus Med Hemother

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Objective: Cost-minimizing analysis (CMA) on adjunct aprotinin application in infected hip revision arthroplasty in a private hospital, specialized in major bone and joint surgery. Patients and Methods: Retrospective (without aprotinin) / prospective (with aprotinin) study in 114 consecutive patients (57 patients in each group), undergoing one-step infected hip revision arthroplasty. After H1/H2 blockade, patients in the aprotinin group received a bolus infusion of 1.5 million kallikrein-inhibiting units (KIU) aprotinin (Trasylol(r)) followed by 500,000 KIU/h for the first 3 h and then 250,000 KIU until the end of operation. Blood loss was estimated by the hematocrit (Hct) method at prefixed times and is given as loss of red blood cell (RBC) mass. Cost data consider acquisition cost of autologous and allogeneic blood products from commencing surgery until discharge and additionally include cost for cross-matching and screening, drugs for H1/H2 blockade, aprotinin, consumables, administration sets until discharge, and volume substitution with crystalloid and colloids until the first postoperative day (POD 1). Statistical analysis included, according to Gaussian/non-Gaussian distribution, t-test/U-test for comparison of means ?(?SD) of continuous variables, and chisquare test for analysis of categorical variables. Statistical significance was considered if p < 0.05. Results: There were no differences between the two groups concerning age, sex, type of anesthesia, estimated blood volume, initial Hct, Hct at discharge, number of autologous units predonated, surgery time, length of stay both on ICU and in hospital. Aprotinin reduced loss of RBC mass by approximately 31% (from 2.9 ???.9 to 2.0 ? 1.1 l; p = 0.001), number of RBC units transfused per patient (from 7.4 ? 5.3 to 4.9 ??3.3 U; p = 0.001), and number of fresh frozen plasma units administered per patient (from 5.1 ??5.2 to 1.7 ??2.8 U; p << 0.001). Transfusion-related cost in aprotinin patients were reduced by approximately 42% (p << 0.001; from EUR 742 ??576 to EUR 431 ??326). Infusion- together with transfusion-related cost in aprotinin patients were by 27.2% lower (EUR 586 ??331) than in control patients (EUR 805 ??592; p = 0.006). Conclusion: This CMA on aprotinin administration in one-step infected hip revision arthroplasty demonstrates that this drug is beneficial for both the patient and the hospital. Aprotinin decreased RBC loss, reduced transfusion of allogeneic blood products, and thereby showed a positive pharmacoeconomic profile for the hospital budget.

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Section: Discussionmentioning

confidence: 71%

Transfusion-Related Cost of Adjunct Aprotinin Application in One-Step Infected Hip Revision Arthroplasty – Cost-Minimizing Analysis

Singbartl¹,

Kantak²,

Munkel³

2001

Transfus Med Hemother

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“…This cost savings has been reproduced by Able and Tilly studying half-dose aprotinin in repeat CABG procedures. 30 They demonstrated a savings of $878 in blood products and $1,088 in total length of stay. When the cost of aprotinin ($450) was subtracted the mean savings per patient was $1,516.…”

Section: Costsmentioning

confidence: 99%

Medical and Economic Impact of Aprotinin Use in Adult Cardiac Surgery

Meyerson

Smith

2004

Transfus Alt Transfus Med

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SUMMARY Aprotinin, a non‐specific serine protease inhibitor, has been conclusively shown to reduce bleeding and transfusion requirements in coronary artery bypass grafting patients supported by cardiopulmonary bypass during surgery. Aprotinin is approved for use in a full‐dose regimen which inhibits kallikrein, plasmin, and premature platelet activation by circulating thrombin. It is also approved for use in a half‐dose regimen which inhibits only plasmin while preserving platelet function as well. With the full‐dose regimen, aprotinin is more effective than the lysine analogues for bleeding endpoints. It also reduces the incidence of perioperative stroke, compared to placebo, while safety in relation to myocardial infarction and death is maintained. The half‐dose regimen is also effective in reducing bleeding and transfusion, but has been associated with increased rates of perioperative myocardial infarction and death, and appears to be less effective in stroke reduction than full‐dose, particularly in high‐risk patients. Full‐dose aprotinin is more effective than half‐dose aprotinin in reducing bleeding and blood transfusion. A comprehensive economic analysis of the randomized trial resource use data has been performed to evaluate the cost‐effectiveness of both aprotinin doses. In primary coronary artery bypass grafting, most of the cost of full‐dose aprotinin and all of the cost of half‐dose aprotinin is recovered by in‐hospital reduction of resource based costs. Further cost savings throughout the patient's lifetime are realized for full‐dose aprotinin due to stroke reduction, ultimately recovering the full cost of the drug. For half‐dose, additional lifetime savings related to stroke reduction are offset by increased lifetime cost of myocardial infarction. In reoperative coronary artery bypass grafting, the use of both full‐ and half‐dose aprotinin led to in‐hospital cost savings of approximately $2,000 per patient. When lifetime costs of complications were considered, an additional savings of $4,000 per patient for full‐dose and $2,000 per patient for half‐dose were realized, primarily through stroke reduction.

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Cost‐Effectiveness of Pharmacological Alternatives

Fergusson

Hutton

2010

Alternatives to Blood Transfusion in Transfusion Medicine

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The effect on costs of the use of half-dose aprotinin for first-time reoperative coronary artery bypass patients

Cited by 8 publications

References 18 publications

Transfusion-Related Cost of Adjunct Aprotinin Application in One-Step Infected Hip Revision Arthroplasty – Cost-Minimizing Analysis

Transfusion-Related Cost of Adjunct Aprotinin Application in One-Step Infected Hip Revision Arthroplasty – Cost-Minimizing Analysis

Medical and Economic Impact of Aprotinin Use in Adult Cardiac Surgery

Cost‐Effectiveness of Pharmacological Alternatives

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