Home Blood Transfusion Research Articles

The impact of sarcopenia on the incidence of postoperative outcomes following spine surgery: Systematic review and meta-analysis.

Sarcopenia is considered to be an important predictor of adverse outcomes following spinal surgery, but the specific relationship between the two is not clear. The purpose of this meta-analysis is to systematically review all relevant studies to evaluate the impact of sarcopenia on spinal surgery outcomes. We systematically searched PubMed, Embase and the Cochrane Library for relevant articles published on or before January 9, 2023. The pooled odds ratio (OR) with 95% confidence intervals (CIs) was calculated in a random effects meta-analysis. The main outcome was the risk of adverse outcomes after spinal surgery, including adverse events and mortality. This systematic review and meta-analysis was conducted following the PRISMA guidelines to evaluate the impact of sarcopenia on spinal surgery outcomes. In addition, we also conducted a subgroup analysis and leave-one-out sensitivity analyses to explore the main sources of heterogeneity and the stability of the results. Twenty-four cohort studies, with a total of 243,453 participants, met the inclusion criteria. The meta-analysis showed that sarcopenia was significantly associated with adverse events (OR 1.63, 95% CI 1.17-2.27, P < 0.001) but was no significantly associated with mortality (OR 1.17, 95% CI 0.93-1.46, P = 0.180), infection (OR 2.24, 95% CI 0.95-5.26, P < 0.001), 30-day reoperation (OR 1.47, 95% CI 0.92-2.36, P = 0.413), deep vein thrombosis (OR 1.78, 95% CI 0.69-4.61, P = 0.234), postoperative home discharge (OR 0.60, 95% CI 0.26-1.37, P = 0.002) and blood transfusion (OR 3.28, 95% CI 0.74-14.64, P = 0.015). The current meta-analysis showed that patients with sarcopenia have an increased risk of adverse events and mortality after spinal surgery. However, these results must be carefully interpreted because the number of studies included is small and the studies are significantly different. These findings may help to increase the clinicians' awareness of the risks concerning patients with sarcopenia to improve their prognosis.

Patient and caregiver perceptions of the possibility of home blood transfusions.

Patients with hematologic malignancies (HM) often develop transfusion dependence. The patient and caregiver burdens associated with the need for frequent transfusions are high. Home blood transfusions has the potential to reduce these burdens, but is not widely practiced in the United States. We designed a qualitative study to evaluate the patient and caregiver perceptions of the potential for a home blood transfusion program. Eligible patients included Adult (≥18 years) patients who were English speaking and met the definition for transfusion dependence within 3 months of study enrollment. We identified and interviewed eligible participants (patients and caregivers), using a semi-structured interview guide to elicit patient perceptions of the acceptability, barriers, and benefits related to home blood product transfusions. Interviews were audio recorded and transcribed. Results were imported into NVivo 12 (version 12; QSR International, Burlington, VT) for coding and analysis. We recruited participants until we reached thematic saturation, which occurred at 29 participants (20 patients, 9 caregivers). Among the 20 patient participants, nine had MDS (45%) and 11 had acute leukemia (55%). Most of the patients (60%) reported getting one transfusion per week. Four themes emerged when the participants discussed their perception regarding the potential of a home blood transfusion program: (1) current in-person experience, (2) caregiver burden, (3) perceptions of home blood transfusions, and (4) interest in participating in a home blood transfusion program. The concept of home blood transfusions was well received and further research to study its implementation is warranted.

Perceptions of a Home Blood Transfusion Program Among Patients with Hematologic Malignancies Who Are Newly Diagnosed As Compared to Those with Relapsed/Refractory Disease

Background: In the United States, home-based blood transfusion programs are not standard of care for patients with transfusion dependent cytopenias, despite the significant burden for patients needing to regularly travel to receive transfusions. While prior research regarding potential benefits of home-based transfusions has focused on patients near the end of life, home-based transfusion services have the potential to reduce patient and caregiver burden for patients with transfusion-dependent hematologic malignancies (HM) across the spectrum of disease. It is imperative to understand the utility of home services in patients at any point in the treatment process. The aim of this study is to compare experiences with hospital-based blood transfusion programs and perceptions of a potential home blood transfusion program in patients with HMs on their first line of treatment versus those who have received 2 or more lines of therapy. Methods:We performed semi-structured interviews with patients with transfusion-dependent HM at Thomas Jefferson University Hospital. Patients were split into two groups; those on first line treatment and those who have received 2 or more lines of treatment. Interviews were transcribed, coded, and analyzed using a content analysis approach. The entire team developed the codebook and coding was conducted by two team members. Coding was monitored with frequent assessments to ensure interrater reliability across codes. Results:We interviewed 20 patients: 11 patients had acute leukemia (55%) and 9 had myelodysplastic syndrome (45%). The median age was 56 (Range: 23-85). 11 (55%) patients identified as female, 12 (60%) as Caucasian, and 5 (25%) as Black/African American. Twelve (60%) patients were on 1 st line treatment and 8 (40%) patients were on 2 nd or 3 rd line treatment at the time of the interview. Patients in both groups felt that familiarity of the care team would be essential for a home transfusion service. This stemmed from concerns of lack of comfort and inconsistency in care experienced with current home care services. Several patients on 2+ lines of therapy felt that individuals with relapsed/refractory disease or those who are physically incapable of going to in-person appointments would benefit the most from home transfusions. Otherwise, patients across both groups had similar concerns about home services, including scheduling issues, a sufficient home environment, and management of complications in the home. Despite such concerns, overall patients in both groups viewed a home blood transfusion program favorably. Most patients agreed that home services would ease inconveniences of transportation and travel time/costs of in-person appointments. Patients also perceived a benefit of increased comfort with home transfusions. Conclusions: Regardless of their stage of treatment, HM patients who depend on transfusions demonstrated comparable levels of openness towards home transfusion services. They also perceived similar benefits and concerns associated with receiving transfusion services at home. The majority of patients perceived increased comfort, convenience, and quality of life with home services, supporting the potential benefit of home transfusion services for transfusion dependent patients across the treatment course and not just at end of life.

Remote vital signs data monitoring during home blood transfusion: A pilot study.

Background and aimsOur study aimed to establish safer methods to manage home blood transfusion by using a remote vital signs data monitoring system. Home care is administered for patients with various medical disorders; however, home blood transfusion remains challenging owing to the risk of transfusion‐related complications.MethodsWe set up a remote vital signs data monitoring system to improve the safety of home blood transfusions. Using an Internet‐based vital signs data monitoring system, the heart rate, electrocardiography, respiration rate, and percutaneous oxygen saturation (SpO2) were monitored and recorded during the entire home transfusion period.ResultsTen transfusions in three patients were monitored; two of the patients had an abnormality in a single vital sign (decreased SpO2 decrease and increased respiratory rate); these were not transfusion‐related complications. Vital sign anomalies also occur because of errors in using the measurement device and noise associated with body movements. The presence of abnormalities in at least two vital signs among SpO2 decrease, tachycardia, and increased respiratory rate that persisted for >5 minutes was defined as a complicated vital sign abnormality (CVSA). There were no severe transfusion‐related complications with CVSA in the present study.ConclusionThis study indicates the feasibility and sustainability of real‐time remote monitoring of vital signs for the safety of home transfusion. Although CVSA may function as an indicator of severe transfusion‐related complications, these findings need to be confirmed with further studies.

Adverse events associated with home blood transfusion: A retrospective cohort study

To determine the rate of individual and system adverse events associated with blood transfusion at home. Home or residential care facility based blood transfusion is beneficial for individuals requiring transfusion due to reduced disruption to daily life and the comfort of a familiar environment. However, blood transfusion may result in serious adverse events. There is a lack of research in this area, and there is a need to identify rates of adverse events and evaluate the system used for this service. Retrospective cohort study. Existing data routinely collected for clinical care were used to determine client and system adverse events of medically stable adults with a chronic disease who underwent blood transfusion in a home setting provided by a nurse-led service. A STROBE EQUATOR checklist was used for this study (see Appendix S1). There were 1790 episodes of care involving 533 participants, with 13 cases of transfusion reaction (incident rate [IR] 0.7%; 95% CI 0.43-1.25). Only five of these were severe, resulting in the cessation of the blood transfusion and further medical review or hospital admission (IR 0.28%; 95% CI 0.12-0.68). There were no cases of tampered blood packaging, expired or visually damaged blood products. There were 10 cases of incorrect paperwork (0.6%) and nine cases of incorrect temperature (0.5%). There were 153 cases of vascular access device adverse events (IR 8.5% 95% CI 7.3-9.9), most commonly, difficulty cannulating the individual (n=82, 54%). A nurse-led home blood transfusion service was associated with low rates of both individual and system adverse events. Further research is needed to explore the perception of those using this service and supports required to improve the experience. Blood transfusions may be associated with increased risk of morbidity and mortality. This risk may be increased in a home setting due to the distance from an acute care facility. This study has demonstrated that a nurse-led home blood transfusion service is safe (<1% adverse event rate) for those with a medically stable, chronic condition. There were few failures in the system used to provide this service. Adverse events associated with the vascular access device were the most common complication and the reason for most blood product wastage. Mainly, this was due to difficulty inserting the short-term peripheral intravenous catheter (PIVC). RNs should consider ultrasound to aid PIVC insertion to facilitate treatment provision and enhance the experience of the individual.

1786P - Homcology: Home chemotherapy delivery in a simultaneous care project for frail advanced cancer patients

BackgroundLimited researches evaluate effectiveness of cancer patients-centered home care management. In this context, patients’ needs rather than prognosis should be considered. Our project represents an opportunity for patients who may benefit from chemotherapy, but with physical and social problems that prevent day-hospital access, and a model of no profit contribution to the Public Health System. MethodsOur Medical Oncology Department, supported by a no-profit organization and according to the GP, conducted the project from May 2014 to March 2019. We included frail patients selected with G8 score (<14), with advanced disease, treated with oral, subcutaneously or parenteral biological agents, with limitations to day-hospital access, comorbidities and at least six months life expectancy. A multidisciplinary team, coordinated by three oncologists, included also four nurses, a pain therapist, a psychologist and a physiotherapist. Satisfaction was evaluated with the FAMCARE scale. ResultsA total of 161 patients (median age of 71 years, range 38-93), were enrolled. Ninety percent of patients had metastatic disease and median G8 score of 8.8 (2.5-13.5). All of them received home cancer treatments and concomitant supportive cares, if necessary; 24 patients received two or more lines of cancer treatment. Considering 148 concluded taking care, median time was 175 days (7-1200). A median number of 254 (195-325) nursing home visits and 164 (139-190) medical home visits were performed each year, with an average of 1.6 and 1.1 visits per month per patient, respectively. Median number of in-line patients was 20 (17-25). Hospitalization occurred in 19.3%. Home blood transfusions were delivered in 6 patients, paracentesis in 8. One third of them died at home. FAMECARE assessed high satisfaction. ConclusionsOur experience demonstrates that the integration of home cancer treatment and supportive care is feasible and effective. Hospitalization rate is lower than data reported in literature. If confirmed in perspective pharmaco-economics studies, our data suggest that home cancer treatments provide high quality assistance to frail patients. Integration with no-profit organization was successful. Our model could be applied in other settings. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Home blood transfusion in France: Benefits and development terms

Patients with cancers or malignant homeopathies can suffer from chronic anemia and be regularly transfused in hospitals. Most of the time, their performance status is low. Few local structures currently provide blood transfusion services and patients have to go under difficult and costing transportation to the hospital. The objective of this work is to evaluate benefits and development terms of home blood transfusion for patients with chronic anemia and having to get transfused regularly. A field investigation-mixing observations and interviews and a literature review were conducted. Home blood transfusion represented a little part of home health care activity. When it was practiced, its organization was heterogeneous: it was sometimes performed by a doctor, sometimes by a nurse. Home blood transfusion was benefic for patients: it was more comfortable and it allowed them to avoid harmful transportation to the hospital. Few adverse events occurred during various experiments, all were mild. Before its revaluation in March 2018, home blood transfusion was not enough funded by National health insurance. Home blood transfusion also suffered from a lack of framework until the publication of recommendations in April 2018. Lack of a framework and sufficient funding prevented home blood transfusion development until changes that occurred in 2018. Therefore, this activity should develop in years to come. Allowing reducing unnecessary hospitalizations, home blood transfusion fit into French health national strategy.

Hematopoietic Stem Cell Transplantation at Home

▪Introduction: Patients receiving autologous (auto) and allogeneic (allo) hematopoietic stem cell transplantation (HCT) typically undergo extensive inpatient hospitalizations, daily “day hospital” visits, or a combination of the two. This aspect of transplant poses a variety of challenges, ranging from nosocomial infections to hospital-induced delirium to lifestyle adjustments. By keeping patients at home, we may lower complications and improve quality of life, as well as potentially lower costs and resource utilization.Methods: We conducted a phase 1 study of home HCT to investigate the safety and feasibility of implementing this strategy in the United States. Patients interested in participating needed to live within a 30 minute drive of a transplant center and underwent a home inspection to assess suitability and safety (e.g. absence of black mold). Eligible patients would still receive pre-transplant conditioning at the hospital or day hospital, but they would be discharged home after receiving their stem cell infusion. The goal was to keep trial participants at home for the duration of transplant. In the morning, nurse practitioners or physician assistants made daily house calls to conduct assessments, examine patients, and draw blood for laboratory studies. These studies were run at the hospital, and in the afternoon a nurse returned to the patient's home to provide home blood transfusions, home intravenous fluids, electrolytes, or antibiotics, or other interventions. If an acute event occurred that could not be safely managed at home (e.g. first evaluation of febrile neutropenia), patients returned to the hospital or day hospital for further workup and care. Likewise, patients returned to the hospital or day hospital for certain routine procedures, such as intravenous methotrexate given as part of graft-versus-host disease prophylaxis or first blood transfusion to ensure there were no reactions. Transplant outcomes were monitored by the medical team throughout the patient's care and confirmed by a clinical research nurse or specialist by chart review. Stool samples, to assess changes in the gut microbiome, were collected at baseline and weekly for the first four weeks, at day 60, 100, and day 180. Samples will undergo 16s rRNA sequencing to identify the taxonomic groups of bacteria present in the gut.Results: Twenty-two patients received home HCT (Table 1). This included 6 allos and 16 autos. Ages ranged from 34-63 years for allos and 46-74 years for autos. In both groups, 2/3 or more of patients had a baseline Karnofsky Performance Status of 70 or 80. Patients in the allo group spent 72% of their days entirely at home, while patients in the auto group spent 52% of their days at home. The main reason for returning to the hospital or day hospital were febrile neutropenia (4 allos and 9 autos). Aside from CMV reactivation (3 of 6 allos, 50%), only 2 allos (33%) and 2 autos (13%) developed bloodstream infections. Three allos developed GVHD; interestingly, these were the three patients that spent the most time in the hospital/day hospital even prior to Day 30 (median 23 days vs. 11 days), even prior to development of GVHD. There was one case of treatment-related mortality (GVHD) in the entire cohort. Overall, patients and their caregivers endorsed the program, providing numerous expressions of appreciation and gratitude on exit interviews, and quality of life was well-preserved as assessed by FACT-BMT: median scores for autos stayed the same when comparing baseline (median 113) to day 30 (median 114) and increased on day 100 (median 124).Discussion: Our results suggest that home HCT is safe and feasible. Despite including mostly older adults with suboptimal performance status, patients did quite well at home. They were able to maintain their quality of life and had low rates of infectious complications. Though patients did have to return to the hospital or day hospital at various times during transplant, keeping patients out of the hospital for even half the duration of transplant could have tremendous cost savings that would offset the increased staffing and travel required for house calls. Studies of the gut microbiome are pending to test the hypothesis that home HCT will preserve the gut microbiome, thereby preventing GVHD. In addition, a randomized phase 2 study of home vs. standard transplant for allogeneic HCT is currently in progress. [Display omitted] DisclosuresSung:Novartis: Research Funding; Merck: Research Funding; Cellective: Research Funding. Gasparetto:Janssen, BMS, Celgene: Consultancy; Janssen, BMS, Celgene: Other: Travel, accommodations, or other expenses paid or reimbursed; Celgene: Research Funding; Janssen, BMS, Celgene, Takeda: Honoraria. Rizzieri:Shire: Research Funding; Erytech: Research Funding.

Understanding the patients’ preferences for home blood transfusion : a willingness to accept-willingness to pay gap analysis

Contexte : De nombreuses études empiriques rapportent des écarts entre disposition à payer (DAP) et disposition à recevoir (DAR), ce qui a fait l’objet d’importantes controverses. Notre principal objectif est d’examiner quelles informations supplémentaires apporte la comparaison des DAP et des DAR sur les préférences des patients atteints de cancer vis-à-vis de la transfusion à domicile. En outre, nous avons recherché si les effets de revenu et de dotation pouvaient expliquer la différence observée entre DAR et DAP dans notre contexte particulier de situation clinique. Méthodes : Une évaluation contingente a été réalisée auprès de patients atteints du cancer et recevant des transfusions soit à leur domicile soit à l’hôpital. Cette étude prospective non randomisée a été effectuée en 2003-2004 au Centre de Lutte contre le Cancer de la Région Rhône-Alpes à Lyon (France). L’ensemble des participants a été interrogé sur sa DAP et sa DAR. Les distributions de DAR et DAP et leur degré relatif de certitude ont été comparés. Des analyses multivariées ont été menées pour étudier la relation entre DAR et DAP. Résultats : De façon générale, les DAR étaient significativement plus élevées que les DAP. Nous avons mis en évidence un effet de dotation (p&lt;0,01) mais pas d’effet du revenu. Un écart positif entre DAR et DAP était aussi plus fréquent parmi les patients à un stade avancé de maladie (p&lt;0,01). Néanmoins, un autre profil intéressant de patients a émergé : les patients avec une faible DAR, dont les préférences semblent cohérentes avec l’hypothèse de « warm-glow ». Toutes choses étant égales par ailleurs, il s’agissait plus fréquemment de femmes (p&lt;0,05), habitant loin de l’hôpital (p=0,05) et à un stade précoce de la maladie (p&lt;0,1). Conclusion : Nos résultats montrent empiriquement que la comparaison des DAR et DAP peut servir à une meilleure compréhension des préférences individuelles vis-à-vis d’un programme de santé ou de l’organisation de soins.

Epidemiology of hepatitis B and hepatitis C virus infections in pregnant women in Sana'a, Yemen.

BackgroundScreening for Hepatitis B and C during pregnancy may help to decide on appropriate antiviral therapy and the institution of steps to minimize vertical transmission to the newborn infants.MethodsA cross-sectional study was conducted during November–December 2011 to investigate the seroprevalence and associated risk factors for markers of HBV (hepatitis B surface antigen; HBsAg) and anti-HCV antibody among pregnant women at the Al-Thawra hospital in Sana’a, Yemen. Structured questionnaires were used to obtain sociodemographic obstetrics and medical data and sera were tested for HBsAg and anti-HCV.ResultsOf the 400 pregnant women enrolled in the study, HBsAg and anti-HCV were detected in 43 (10.8%; 95% CI: 8.0–14.0%) and 34 (8.5%, 95% CI: 6.0–11.5%) women, respectively. None of the women were co-infected with HBV and HCV. Multivariate analysis showed that circumcision was significantly associated with HBsAg seropositivity (OR = 3.3, 95% CI: 1.1–10.2; p = 0.03), low parity (primigravidae and secundigravidae) and education below secondary level were significantly associated with anti- HCV seropositivity (OR = 3.3, 95% CI: 1.1–10.2; p = 0.03). No other sociodemographic or clinical characteristics (age, residence, history of home delivery, miscarriage, dental manipulation, surgery, and blood transfusion) were significantly associated with HBsAg or anti-HCV seropositivity.ConclusionThe results of this study suggest that HBsAg and anti-HCV have high prevalence among pregnant women.

Valuing the Benefit for Cancer Patients of Receiving Blood Transfusions at Home

In the field of health care management, contingent valuation surveys (CV) are used in cost benefit analyses (CBA) to elicit patients’ monetary valuation of program benefits. We considered the empirical situation of blood transfusions (BT) in cancer patients. Before planning such a CBA, we had to make sure that the CV approach could be used in a particularly critical clinical situation to estimate the marginal benefit of changing from hospital BT to home BT. The fact that the CV approach is feasible and acceptable to severely ill patients was not taken for granted a priori.We measured patient’s willingness-to-pay (WTP) for home BT in a sample of 139 patients who received transfusions either at home or in the hospital. After considering patient’s participation to the survey and protest responses, we identified possible determinants of WTP values derived from previous knowledge, then we compared their expected influences to predicted influences resulting from econometric analysis to assess the validity of our results. Participation was high (90%) and few patients gave protest responses. Most patients (65%) had received home care, including 43% BT. The median WTP for home BT was 26.5 € per patient.Good consistency was observed between the expected and predicted influences of possible determinants of WTP. The anchoring bias hypothesis was confirmed. The WTP for home BT increased with previous experience of home care, age, living far from the hospital and low quality of life. Our CV approach is thus a first contribution to the debate on the appropriateness of generalizing access to home BT. However, our results would be worth confirming with a formal cost-benefit analysis.

Cancer patients’ willingness to pay for blood transfusions at home: results from a contingent valuation study in a French cancer network

Home blood transfusion may be an interesting alternative to hospital transfusion, especially when given with curative or palliative intent or for terminal care in advanced-stage cancer patients. However, there is limited information about patients' attitude toward this type of care. The purpose of this study was to measure French cancer patients' willingness to pay (WTP) for home blood transfusion and to analyze determinants of their choice. A contingent valuation survey was administered to 139 patients receiving transfusions in the framework of a regional home care network or in the hospital outpatient department. Participation was high (90%). Most patients (65%) had received home care, including 43% blood transfusions. Just under half of the patients gave a zero WTP, among which we identified 8 protest bidders. The median WTP for home blood transfusion was 26.5 <euro> per patient. In multivariate analysis, long home-hospital distance, poor quality of life, and previous experience of home care were identified as important factors in determining how much more patients would be willing to pay for transfusion at home. These results demonstrate the benefits of developing domiciliary services to improve patient well-being, notably for the weakest among them. The significant impact of previous home care experience on WTP is probably related to the strong involvement of physicians from the blood center and to their active contribution to a high-level homecare network. Some of our findings could be useful for policy decision-making regarding home care.

338 Home blood transfusions: feasibility and safety, three years of experience in myelodysplastic syndromes

338 Home blood transfusions: feasibility and safety, three years of experience in myelodysplastic syndromes

Transfusion en hospitalisation à domicile

Context The development of alternatives to hospitalization including home medical care (HAD), an aging population and a more secure transfusion raises the question of the feasibility of home blood transfusion. The legislation allows the home blood transfusion under specified conditions, but when they are met, the texts on nursing care and the transfusion gesture may hamper this progress. Methods We report our experience of 3 years: a protocol was established to do home blood transfusions by trained transfusion nurses from the HAD. Six patients were eligible for transfusion at home but only three of them could be treated at home. Moreover, since late 2009, the Nursing Department no longer allows this practice for legal reasons. At the same time, a questionnaire was sent to 224 HAD to find out about their practice on the subject. Discussion In the light of practices in different countries, earnings for the quality of life of the patient, lack of space in hospitals and the aging population, it seems essential to change the law to permit a rational transfusion, thoughtful, safe for the patient at home and for caregivers who are involved.

Blood transfusions at home or in the hospital? The preferences of cancer patients

Home blood transfusion (HBT) is as safe and effective as hospital transfusion. If HBT can potentially cause anxiety, it can also improve patients' quality of life. The different factors influencing patients' preference for home or hospital are examined on the basis of a prospective study including 139 patients from the comprehensive cancer center of Lyon, and who received transfusions in the hospital outpatient department or at home between 2003 and 2004. A Probit model was used to identify the determinants of the choice of place of transfusion. The intensity of preference for this choice was assessed with the contingent valuation method. Of 139 patients included in the study, 97 chose HBT in the eventuality of a new transfusion. This preference was significantly related to a previous experiment of HBT and to the distance between patient's home and hospital. Mean willingness to pay was 60.9 euro for home and 47.3 euro for hospital transfusion. These results, in favour of HBT, are probably related to the strong involvement of physicians of the blood centre and their active collaboration with a high-level homecare network.

Analyzing the Determinants of Willingness-to-Pay Values for Testing the Validity of the Contingent Valuation Method: Application to Home Care Compared to Hospital Care

The contingent valuation (CV) method is an attractive approach for comparing home care to hospital care in which the only difference is patients' well-being during the treatment process and not health outcomes. We considered the empirical situation of blood transfusion (BT) in cancer patients and collected willingness to pay (WTP) values among BT users. Our main objective was to test the validity of the CV method, namely its ability to elicit true preferences. Firstly, possible determinants of WTP values and their expected influences were identified, from both economic and non economic literature and from the findings of a pilot study. Secondly, they were compared to predicted influences resulting from appropriate econometric analysis of WTP values elicited by a bidding process. From the health economics literature it appeared that the double-hurdle model is the most appropriate approach to account for zero values and protest responses. However, because the number of protest responses was too small, we used a truncated regression model. None of the 7 hypothesized influences was invalidated by econometric results. The anchoring bias hypothesis was confirmed. The WTP for home BT compared to hospital BT increased with household income, with previous experience of home care, with living far from the hospital and with low quality of life. Conversely, it was lower for advanced-stage (palliative or terminal) than for early-stage (curative) patients. We conclude that the CV approach is acceptable to severely ill patients. Moreover, WTP values demonstrate good validity given that influences predicted by our model are consistent with expected determinants.

Analyzing the Determinants of Willingness-to-Pay Values for Testing the Validity of the Contingent Valuation Method: Application to Home Care Compared to Hospital Care

The contingent valuation (CV) method is an attractive approach for comparing home care to hospital care in which the only difference is patients’ well-being during the treatment process and not health outcomes. We considered the empirical situation of blood transfusion (BT) in cancer patients and collected willingness to pay (WTP) values among BT users. Our main objective was to test the validity of the CV method, namely its ability to elicit true preferences. Firstly, possible determinants of WTP values and their expected influences were identified, from both economic and non economic literature and from the findings of a pilot study. Secondly, they were compared to predicted influences resulting from appropriate econometric analysis of WTP values elicited by a bidding process. From the health economics literature it appeared that the double-hurdle model is the most appropriate approach to account for zero values and protest responses. However, because the number of protest responses was too small, we used a truncated regression model. None of the 7 hypothesized influences was invalidated by econometric results. The anchoring bias hypothesis was confirmed. The WTP for home BT compared to hospital BT increased with household income, with previous experience of home care, with living far from the hospital and with low quality of life. Conversely, it was lower for advanced-stage (palliative or terminal) than for early-stage (curative) patients. We conclude that the CV approach is acceptable to severely ill patients. Moreover, WTP values demonstrate good validity given that influences predicted by our model are consistent with expected determinants.

Home blood transfusion, a four-year experience

1. Nursing professionals being involved with too many patients, resulting in a diYculty in delivering routine support, such as a shift in position to avoid pressure sores, with the necessary frequency. 2. Infections due to resistant microorganisms (hospital infection), demanding prolonged antibiotic therapy. 3. IneYcient physiotherapy (motor and respiratory), due to the large number of patients to be treated, resulting in delayed recovery of basic functions or even delayed ventilator weaning. 4. Psychological weakness and lowering of selfesteem due to less frequent contact with relatives.

Home blood transfusion: a necessary service development

An alternative to the transfusion of blood and platelets in hospital was assessed with the aim of reducing the demand on acute services and the need for hospital admission. Patients and general practitioners [GPs] were surveyed before a home blood transfusion service was set up. The majority of GPs and patients did not support the scheme initially. After the service was set up, all patients who received home transfusion stated that this was more convenient. We feel that by avoiding unnecessary emergency admissions, which account for up to 40% of all admissions to NHS hospitals, and improving the capacity of our day unit, we are providing a better service for local patients. More widespread use of home transfusion services should be encouraged.

The Feasibility and Advisability of Administering Home Blood Transfusions to the Terminally Ill Patient

The Feasibility and Advisability of Administering Home Blood Transfusions to the Terminally Ill Patient