Accurate costs of blood transfusion: a microcosting of administering blood products in the United Kingdom National Health Service

Stokes, Elizabeth A; Wordsworth, Sarah; Staves, Julie; Mundy, Nicola; Skelly, Jane V.; Radford, Kelly L.; Stanworth, Simon

doi:10.1111/trf.14493

Cited by 55 publications

(40 citation statements)

References 16 publications

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“…13 The mean costs per unit for administering transfusions to a patient are $71 for red blood cells (RBCs), $84 for platelets, $55 for fresh-frozen plasma, and $72 for cryoprecipitate. 14 The inherent limitations of this study include its retrospective design and relatively small sample size. Our study is not generalizable to the pediatric population since only adult patients were included in our analysis.…”

Section: Discussionmentioning

confidence: 98%

“…In an average 70 kg patient with a theoretical measured AT activity of 40%, it is estimated that 1500 units of drug are needed to fully reach an optimal AT target, which may cost the patient up to $4000 13 . The mean costs per unit for administering transfusions to a patient are $71 for red blood cells (RBCs), $84 for platelets, $55 for fresh‐frozen plasma, and $72 for cryoprecipitate 14 …”

Section: Discussionmentioning

confidence: 99%

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Heparin vs bivalirudin anticoagulation for extracorporeal membrane oxygenation

et al. 2020

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Background Extracorporeal membrane oxygenation (ECMO) induces hemostatic alterations that may contribute to hematological complications. Unfractionated heparin (UFH) is the mainstay antithrombotic in ECMO and depends on antithrombin III (AT III) to exhibit its actions. However, it bears the risk for heparin‐induced thrombocytopenia. Bivalirudin is a direct thrombin inhibitor and is inherently not dependent on AT III. Aim of the Study To assess the efficacy and safety profiles of UFH compared with bivalirudin during ECMO support. Methods We retrospectively reviewed 52 adult patients who were supported by ECMO from 1 January 2013 to 1 September 2018. Among them, 33 received UFH and 19 received bivalirudin. We analyzed their 7‐day rate of composite thrombotic, bleeding, and mortality episodes while on anticoagulation. Results There were no statistical differences in the 7‐day rate of composite thrombosis (33.3% vs 26.3%; P = 0.60), major bleeding (18.2% vs 5.3%; P = .24), 30‐day mortality, (42.4% vs 26.3%; P = .37), or in‐hospital mortality (45.5% vs 36.8%; P = .58). The percentage of time activated partial thromboplastin time (aPTT) was within the therapeutic range was higher with bivalirudin (50% vs 85.7%; P = .007). Conclusions This study suggests that UFH and bivalirudin are associated with similar rates of thrombosis, major bleeding, and mortality events in patients supported by ECMO. However, it was observed that bivalirudin consistently maintained aPTT within the therapeutic range in comparison to UFH.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Heparin vs bivalirudin anticoagulation for extracorporeal membrane oxygenation

et al. 2020

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“…In all Canadian provinces except Quebec, Canadian Blood Services provides blood products to hospitals free of charge . In health systems where there are currently no obvious fiscal incentives for hospitals to control the use of blood products, the existing payment framework for blood products may be an obstacle to the effective control of IVIG administration …”

Section: Discussionmentioning

confidence: 99%

Trends in IVIG use at a tertiary care Canadian center and impact of provincial use mitigation strategies: 10‐year retrospective study with interrupted time series analysis

et al. 2019

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BACKGROUND: Intravenous immunoglobulin (IVIG) is a fractionated plasma product used to treat a range of autoimmune or inflammatory conditions, as well as immunodeficiency. Demand for this high-cost product is increasing worldwide. Understanding historical changes in IVIG use is important for inventory management and demand forecasting as well as for the development of initiatives aimed at optimizing blood product use. ABBREVIATIONS: ITS = interrupted time series; IVIG = intravenous immunoglobulin; SCIG = subcutaneous immunoglobulin.From the

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“…Finally, the cost of RBCs for transfusion is estimated to be significant at US $761 (€692, exchange rate 29 November 2019) per unit. Even in countries that do not purchase blood for hospital use, the cost of administering units of blood is high.…”

Section: Introductionmentioning

confidence: 99%

Phlebotomy resulting in controlled hypovolaemia to prevent blood loss in major hepatic resections (PRICE-1): a pilot randomized clinical trial for feasibility

Martel

Baker

Wherrett

et al. 2020

British Journal of Surgery

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Background: Major liver resection is associated with blood loss and transfusion. Observational data suggest that hypovolaemic phlebotomy can reduce these risks. This feasibility RCT compared hypovolaemic phlebotomy with the standard of care, to inform a future multicentre trial.Methods: Patients undergoing major liver resections were enrolled between June 2016 and January 2018. Randomization was done during surgery and the surgeons were blinded to the group allocation. For hypovolaemic phlebotomy, 7-10 ml per kg whole blood was removed, without intravenous fluid replacement. Co-primary outcomes were feasibility and estimated blood loss (EBL).Results: A total of 62 patients were randomized to hypovolaemic phlebotomy (31) or standard care (31), at a rate of 3⋅1 patients per month, thus meeting the co-primary feasibility endpoint. The median EBL difference was −111 ml (P = 0⋅456). Among patients at high risk of transfusion, the median EBL difference was −448 ml (P = 0⋅069). Secondary feasibility endpoints were met: enrolment, blinding and target phlebotomy (mean(s.d.) 7⋅6(1⋅9) ml per kg). Blinded surgeons perceived that parenchymal resection was easier with hypovolaemic phlebotomy than standard care (16 of 31 versus 10 of 31 respectively), and guessed that hypovolaemic phlebotomy was being used with an accuracy of 65 per cent (20 of 31). There was no significant difference in overall complications (10 of 31 versus 15 of 31 patients), major complications or transfusion. Among those at high risk, transfusion was required in two of 15 versus three of nine patients (P = 0⋅326).Conclusion: Endpoints were met successfully, but no difference in EBL was found in this feasibility study. A multicentre trial (PRICE-2) powered to identify a difference in perioperative blood transfusion is justified. Registration number: NCT02548910 (http://www.clinicaltrials.gov).

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Accurate costs of blood transfusion: a microcosting of administering blood products in the United Kingdom National Health Service

Cited by 55 publications

References 16 publications

Heparin vs bivalirudin anticoagulation for extracorporeal membrane oxygenation

Heparin vs bivalirudin anticoagulation for extracorporeal membrane oxygenation

Trends in IVIG use at a tertiary care Canadian center and impact of provincial use mitigation strategies: 10‐year retrospective study with interrupted time series analysis

Phlebotomy resulting in controlled hypovolaemia to prevent blood loss in major hepatic resections (PRICE-1): a pilot randomized clinical trial for feasibility

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