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

Abstract

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.

Aprotinin – a Blood-Saving Substance

“…In order to assess cost-effectiveness, Singbartl et al [16] have performed a cost-minimizing analysis on adjunct aprotinin application in high-risk orthopedic patients. They retrospectively (without aprotinin) / prospectively (with aprotinin) studied 114 consecutive patients (57 patients in each group) undergoing one-step infected-hip revision arthroplasty.…”