PHP159 - PUBLIC HEALTH AND ECONOMIC VALUE OF A NATIONWIDE PATIENT BLOOD MANAGEMENT PROGRAM

Abstract

Patient Blood Management (PBM) is an evidence-based, multidisciplinary approach aiming to optimize patients’ own blood in order to improve clinical outcomes and healthcare expenditure. This research set out to assess the public health and economic value of a nationwide PBM program in Portugal. A mathematical decision-model was developed to estimate the impact of a nationwide PBM program over a one-year time horizon. Hospital-attended patients from the following therapeutic areas were considered: surgery (orthopaedic/cardiac/urologic), cardiology, oncology, gastrointestinal bleeding, abnormal uterine bleeding, haemodialysis, inflammatory bowel disease and pregnancy. Model inputs, obtained from Portuguese national health databases and literature review, included effectiveness and cost data on PBM strategies, transfusion utilization, hospitalization, mortality, physician visits and drug use. Model structure and inputs were validated by a national expert panel. For an estimated 384,704 patients eligible for PBM strategies, a reduction in the proportion of red blood cell (RBC) transfused patients of 51.2% could be obtained (-17,202 patients), associated with a reduction in the number of transfused RBC units of 57.3% (-65,214 units). Due to an estimated 8.4% and 37.3% decrease in hospital length of stay and readmissions, respectively, 233,141 in-hospital days could be avoided. Furthermore, in-hospital mortality could reduce by 594 cases, resulting in 1,481 life-years gained. Although an increase in drug use and physician visits would lead to an estimated additional €24.1 million in costs, these would be counterbalanced by €91.9 million in savings, mainly due to €70.4 million in hospitalization costs and €17.6 million in RBC transfusions. Net savings of over €67.7 million could be expected, equivalent to a 6.3% reduction in the public expenditure of this population. The implementation of a nationwide PBM program in Portugal could result in a substantial improvement in public health outcomes with high economic value to the national health system.