Platelet transfusions: Utilization and associated costs in a tertiary care hospital

Abstract

We implemented a prospective study to evaluate platelet transfusion utilization, resource use, and costs in a tertiary care hospital over a 6-month period. All hospitalized patients receiving platelet transfusions between July and December 1996 were followed prospectively to determine platelet use and costs. Clinical and financial data were collected, evaluated, and compared to identify trends in resource utilization based on admitting service and platelet-refractory status. One thousand nine hundred forty-four platelet units were transfused to 245 hospitalized patients (50.6% male, mean age 49 years) during the study period. The majority of platelet units transfused were single donor (N = 1,460, 75%) and administered to bone marrow patients and patients with a hematological malignancy/disorder. Median hospitalization costs per admission were $27,750, ranging from a high of $58,729 for admission to the Bone Marrow Transplant service to $13,856 per admission to the Internal Medicine/Other service. Patients were refractory to platelet transfusions during 21.6% of hospitalizations. Hospital stays were longer (35.0 days vs. 14.4 days, P < 0.001) and inpatient hospital costs ($103,956 vs. $37,817, P < 0.001) were more than two and a half times higher for patients refractory to platelet transfusions. Platelet utilization, resource use, and costs vary by admitting service. Refractoriness to platelet transfusion was associated with significantly greater costs and lengths of stay. Monitoring platelet transfusion practices, particularly for patients refractory to platelet transfusions, may be beneficial for limiting costs and improving efficacy.

Cost of chemotherapy‐induced thrombocytopenia among patients with lymphoma or solid tumors

“…In that prospective study of costs and platelet transfusion utilization, patients with refractory status accounted for 66% of all platelet transfusions. 31 For this reason, the incremental cost of thrombocytopenia may be underestimated in our study.…”

“…These costs can be substantial, and up to 20% of patients may become refractory to platelet transfusion during the course of therapy. 31,38,39 Meehan reported a two-fold increase in the cost of hospitalization of platelet refractory patients compared with those who received platelet transfusion but were not refractory. In that prospective study of costs and platelet transfusion utilization, patients with refractory status accounted for 66% of all platelet transfusions.…”

“…A random sample of 75 adult patients, stratified by underlying cancer, was selected from among all patients with solid tumors or non-Hodgkin lymphoma who developed chemotherapy-induced thrombocytopenia between January 1, 1995 and December 31,1996. Among these, 41% were males, 56% had metastatic disease, 15% had bone marrow metastases, and 3% had a Zubrod performance status Ͼ 2.…”

Factors influencing post-transfusional platelet increment in pediatric patients given hematopoietic stem cell transplantation

“…As a consequence, refractory patients are more often exposed to the risk of transfusion-related adverse events, such as hepatitis, and cost more to treat. 1 Although leukocyte reduction and ultraviolet B irradiation have lowered the frequency of refractoriness to PC transfusion, this problem still occurs in a significant percentage of cases, especially in the clinical setting of HSCT where up to 60% of transfusions are ineffective. [2][3][4] Identification of the likely reason for refractoriness in a given individual patient should allow prevention of the problem and development of strategies capable of improving both transfusion practice and patient outcome.…”

Targeted Approaches for the Treatment of Thrombocytopenia

“…Associated costs include disposable materials (processing and administration), storage, management of inventory, outdating, wastage, HLA typing, record keeping, and nursing time to administer and evaluate potential reactions [5]. Refractoriness to platelet transfusions is associated with significantly greater inpatient costs and length of stay [11]. Efforts have been made to control costs and increase efficiency of transfusion practices by utilizing lower-dose single-donor platelet transfusions, but this practice may actually increase overall hospital transfusion costs [12].…”