Cost Analysis of Aprotinin Reintroduction in French Cardiac Surgery Centres: A Real-World Data-Based Analysis

Abstract

Introduction:The European Medicines Agency restored aprotinin (APR) use for preventing blood loss in patients undergoing isolated coronary artery bypass graft (iCABG) in 2016 but requested the collection of patient and surgery data in a registry (NAPaR). The aim of this analysis was to evaluate the impact of APR reintroduction in France on the main hospital costs (operating room, transfusion and intensive unit stay) compared to the current use of tranexamic acid (TXA), which was the only antifibrinolytic available before APR reinstatement. Methods: A multicenter before-after post-hoc analysis to compare APR and TXA was carried out in four French university hospitals. APR use

Lack of efficacy of aprotinin over tranexamic acid in type A aortic dissection repair

“…A recent French study evaluating the economic impact of aprotinin noted that in complex surgery, including aortic dissection repair, surgical and transfusion costs were similar between patients receiving TXA and aprotinin. The cost of antifibrinolytics was 125 times greater in the aprotinin group 31 . In our hospital aprotinin costs £79 per vial, approximately £1500 per case, by comparison TXA costs £1.50 per vial, approximately £20 per case—a 75‐fold difference.…”

“…The cost of antifibrinolytics was 125 times greater in the aprotinin group. 31 In our hospital aprotinin costs £79 per vial, approximately £1500 per case, by comparison TXA costs £1.50 per vial, approximately £20 per case-a 75-fold difference. The lack of any benefit in transfusion, outcomes, or use of healthcare resources makes it debatable if the added cost of aprotinin provides good value for money in emergency type A dissection repair.…”