Cost-Effectiveness and Budget Impact of Comprehensive Anemia Management, The First Pillar of Patient Blood Management, on the Turkish Healthcare System.

Abstract

PurposePatient blood management (PBM) is a patient-centered, evidence-based, multidisciplinary approach aimed at optimizing hemoglobin concentration, ensuring the continuity of hemostasis and minimizing blood loss in patients undergoing surgery. The aims of this study were: (1) to explore the cost-effectiveness of comprehensive anemia management, the first pillar of PBM, in non-cardiac and cardiac surgery from the Turkish Social Security Institution’s (SSI’s) perspective; and (2) to explore the potential budget impact of PBM for coronary artery bypass grafting (CABG) and hip and knee arthroplasty to the SSI.MethodsCost-effectiveness and budget impact models were developed based on the avoided postoperative adverse events following implementation of the first pillar of PBM for non-cardiac and cardiac surgical patients. The probabilities of adverse events (sepsis with and without pneumonia, renal failure, myocardial infarction and stroke) were taken from a recent meta-analysis and the costs of treating these adverse events to the SSI were estimated through expert views and the use of SSI guidelines.ResultsThe PBM arm dominated the control arm for both non-cardiac and cardiac surgeries in terms of cost-effectiveness in the simulated cohort of patients and was associated with improved outcomes and lower costs (1768 and 1244 avoided adverse events, and incremental cost reductions for non-cardiac and cardiac surgery of 7504 Turkish lira [TRY] and 6102 TRY, respectively). The budget impact analysis showed that PBM is a potential cost-saving option for the SSI, with savings of up to 196,937,705 TRY (€12,841,697) for hip and knee arthroplasty and 24,642,504 TRY (€1,606,861) for CABG surgery.ConclusionPBM is a cost-effective option with a potential of cost-saving for cardiac and non-cardiac surgery in Turkey.