Transfusion Costs Research Articles

Abstract A001: A prospective study of anemia in cancer patients undergoing chemoradiation using serial hemoglobin measurement in North Central region, Nigeria

Abstract Background: Multiple Studies have suggested that aside from its important role in quality of life (QOL) issues, anemia constitutes an independent prognostic factor of survival, response to treatment, loco-regional control and recurrence in patients with cancer concurrent chemotherapy and radiotherapy (i.e. Chemoradiation). This treatment modality is for selected cancer types and patients but may be complicated, especially in low and middle income countries where nutritional anemia is already prevalent. Aim: A prospective study of anemia in cancer patients undergoing chemoradiation using serial hemoglobin measurement. Materials and Method: The study consists of 38 patients with solid cancers who meet inclusion criteria. The baseline hemoglobin (Hb) level was taken and recorded on first day of consultation. Their Hb level was measured every 2 weeks during concurrent radiotherapy and chemotherapy. The blood film pictures at pre-treatment and ongoing treatment were examined and analyzed by a team of Ha Hematologists. The whole process was terminated after 3 consecutive Hb measurement or after week 6. Anemia was classified for this study as follows: Less than10g/dl– Severe Anemia 10–10.9g/dl–Moderate Anemia 11–11.9g/dl–Mild Anemia 12–12.9g/dl–No Anemia. Results: 38 out of 72 cancer patients recruited for this study met inclusion criteria. Age range was 25–75 years with median age of 50years. 27/38 (71/1%) of patients were female while 11/38 (28.9%) were male with ratio of 2:1. 61.2% had Pelvic and 38.8% had head and neck regions as cancer sites that received chemoradiation. More than 75% of patients presented with stage III diseases which was evident of advanced stage and a strong indication for chemoradiation. At week 6, 39.6% cancer patients undergoing chemoradiation had mean haemoglobin value of 10-10.9g/dl. At p value >0.05 there was no statistical significance in distribution of mean Hb, standard deviation based on sex for cancer patients on chemoradiation. Conclusion: The prevalence of anaemia in 38 cancer patients undergoing concurrent chemoradiation was 73.6%. With adequate Hb monitoring during therapy, chemoradiation has no significant effect on Hb level. At 95% confidence interval, the impact of chemoradiation on Hb level during therapy i.e. week 6 was 10.98-11.3g/dl. Despite this result, anemia remains a big challenge to overall quality of life and survival in cancer patients especially in resource constrained environment like Nigeria where nutritional anemia is common and blood transfusion services may be in adequate in certain areas with attendant out of pocket health care cost of blood transfusion. Recommendation: This paves way for more questions and need for further research on our patient population on the relationship between anemia, hypoxia, use of hyperbaric oxygen, radiosensitizers, antihelminthics etc. as anemia remains independent prognostic factor in patients with cancer in our environment. Citation Format: Simeom Chinedu Aruah. A prospective study of anemia in cancer patients undergoing chemoradiation using serial hemoglobin measurement in North Central region, Nigeria. [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Translating Targeted Therapies in Combination with Radiotherapy; 2025 Jan 26-29; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(2_Suppl):Abstract nr A001.

Resuscitation of adult shocked trauma patients using major haemorrhage protocol guided by viscoelastic haemostatic assays versus formulaic approach.

The resuscitation of trauma patients with critical bleeding may follow a formulaic approach using high ratios of blood components or a viscoelastic haemostatic assay (VHA) guided approach. The aim of this study was to compare the two strategies for resuscitation of shocked trauma patients. This was a registry-based cohort study including shocked trauma patients from two trauma centres-one practising a formulaic approach, with VHA unavailable during trauma resuscitation and the other practicing a VHA-guided resuscitation strategy. The primary outcome was the total units of blood components transfused in 24 h after adjusting for differences in baseline characteristics and time to death. Between 01 Jan 2020 and 31 Dec 2022, 152 eligible patients were categorised to the formulaic group and 40 to the VHA group. Prehospital times were longer in the formulaic group (2.0 vs. 1.4 h), and more patients in the VHA group (38% vs. 17%) were transfused prehospital blood components. Formulaic resuscitation was associated with significantly more blood components transfused (adjusted incidence rate ratio 1.5; 95%CI: 1.4-1.7, p < 0.001). Using a formulaic approach, patients were administered more red blood cells, plasma and platelets, but fewer cryoprecipitate. There was no significant association of the formulaic approach with in-hospital mortality (adjusted odds ratio 2.4; 95%CI: 0.7-8.0, p = 0.17). Given the cost and potential adverse effects of blood component transfusions, VHA-guided transfusion strategies present an attractive option, particularly among centres managing high volumes of shocked patients. Further trials, enrolling the population most likely to benefit from precision transfusion strategies, are indicated.

Clinical and economic benefits of patients undergoing lobectomy with the use of powered vascular staplers—based on China’s real-world data

Background Endoscopic surgery is widely performed with an increasing use of powered vascular staplers (PVS). However, few studies have examined PVS use in China, most of which have focused on clinical effects; fewer studies have examined the economic benefits of PVS. This study evaluated the clinical and economic benefits of the PVS compared to standard-of-care (SOC) staplers in lobectomy using results from a single-arm, multicenter clinical trial conducted in China and actual clinical use in a hospital collected in a real healthcare setting. Methods Patients with lung cancer undergoing thoracoscopic lobectomy were included in the study. The clinical and economic benefits of powered vascular stapler have been evaluated from a hospital’s perspective based on parameters such as bleeding occurrence, hospitalization time, secondary thoracotomy, and hospitalization costs. To compare the bleeding associated with use of PVS and SOC stapler in clinical use, PVS single-arm multi-center clinical trial data is used for the intervention group, and sampling data from hospitals is used for the control group. To ensure the outcome indicators between the two groups are comparable, we set the same inclusion criteria for the two groups of data and then used propensity score matching (PSM) to match two groups of patients according to the baseline characteristics. Results The results show that bleeding incidence in patients with SOC stapler group is 17.33% from hospital sampling data. In contrast, in the PVS group, it is 4.00%, and these rates are statistically different (p = 0.0167). Considering converted to open thoracic surgery, the rate of the SOC stapler group is 5.78% and that of the PVS group is 4.00%. These rates are not statistically different (p = 0.6166). Regarding hospitalization days, the length of the SOC stapler group is 18.97 days, while that in the PVS group is 12.38 days, and these data are statistically different (p = 0.0002). As patients in the PVS group have reduced bleeding, they will require less resource use from blood transfusion, drug services, and surgical services. If PVS is used for transection of vessel, it can reduce the bleeding incidence by 13.33% and save 75.47 CNY in blood transfusion costs, 571.36 CNY in drug costs, and 183.38 CNY in surgical service costs per patient. From these three aspects, the hospital saves per patient 830.21 CNY. Conclusions Compared with the SOC stapler group, the PVS group has a lower bleeding incidence and shorter hospital days for lobectomy. In terms of blood transfusion costs, drug costs, and surgical service costs, the hospital saves per patient 830.21 CNY.

Cost Reduction in Blood Transfusions After Implementation of Decision Protocol Based on Hemoglobin and Anemia Symptoms: A Pre-Post Analysis.

BACKGROUND Blood products are an expensive resource. The study aimed to assess the cost spent on red blood cell (RBC) transfusions before and after implementing a 2-factorial RBC transfusion decision protocol and the current cost of an RBC transfusion procedure in the local healthcare system. MATERIAL AND METHODS Six-month periods before and after the implementation of the decision protocol were compared. The cost components considered included RBCs, laboratory tests, labor of healthcare workers involved in the procedure, and management of transfusion reactions. RESULTS Following the implementation of the decision protocol, there was a decrease in transfusion costs by €51,411 (56.4%) in our low transfusion rate setting. Inappropriate RBC transfusions amounted to €25,0146 (62.9% of all transfusions costs). The cost of a leucodepleted RBC transfusion increased in the periods being compared, from approximately €109 to €126 in the local healthcare system. CONCLUSIONS Implementing an RBC transfusion decision protocol based on a 2-factorial approach can lead to a more than 2-fold reduction in cost spent on RBC transfusions in a low transfusion rate setting. Even after the implementation of the protocol, further education of clinicians is required, as there may still be potential to reduce costs associated with inappropriate transfusions. The non-RBC acquisition cost of an RBC transfusion procedure approximates the cost of a blood component itself in the local healthcare system.

Evaluation of staged autologous blood transfusion during extracorporeal membrane oxygenation decannulation: A retrospective study

BackgroundClinical blood resources are scarce and autologous blood transfusion for extracorporeal membrane oxygenation (ECMO) withdrawal is less studied. ObjectivesTo assess the use of staged autotransfusion during ECMO decannulation. MethodsThe study included ECMO withdrawal patients. Patients in the autologous transfusion group underwent staged transfusion during ECMO withdrawal, while those in the control group received 2.0 units of allogeneic packed red blood cells (RBCs) to increase hemoglobin (Hb). Parameters such as Hb, hematocrit (Hct), adverse events, decannulation success rate, volume of allogeneic RBC transfusions, and transfusion costs were compared. ResultsA total of 82 Chinese patients were enrolled, with a mean age of 46 years, 27 were female, and the top three primary diagnoses were cardiac arrest, acute myocarditis, and severe pneumonia. There were 41 individuals in the autologous blood transfusion group and 41 in the control group. No significant differences were observed in Hb, Hct, adverse events, and the success rate for decannulation between the two groups (all P > 0.05). Compared with the control group, the volume of allogeneic RBC transfusions [0 (0∼1.50) U vs. 3.5 (1.88∼40) U, P < 0.001] and the total cost [130 (130∼390) Chinese Yuan (CNY) vs. 910 (487.50, 1040) CNY, P = 0.002] were lower in the autologous transfusion group. ConclusionIn comparison with allogeneic RBC transfusion, staged autotransfusion during ECMO decannulation not only effectively maintained Hb levels but also reduced the requirement for allogeneic RBC transfusions. In addition, this approach decreased the associated costs and did not increase the risk of clinical adverse events.

Machine learning opportunities to predict obstetric haemorrhages

Obstetric hemorrhages (OH) are the main preventable cause of morbidity, mortality and cases of "near miss" among obstetric complications worldwide. Early preventive measures based on the OH prediction allow to profoundly reduce the rate of female mortality and morbidity as well as prevent the economic costs of patient intensive care, blood transfusion, surgical treatment and long-term hospitalization. Postpartum haemorrhage (PPH) is the most frequent obstetric haemorrhage determined by one of the four causes: a uterine tonus disorder, maternal birth trauma, retention of placenta parts and blood-clotting disorder. There is still a need for the continued search for an accurate and reliable prediction method despite multiple attempts to develop an effective system for predicting OH. The solution to this may be reasonably considered an innovative method such as artificial intelligence (AI) including computer technologies capable of obtaining conclusions similar to human thinking. One of the particular AI variants is presented by machine learning (ML), which develops accurate predictive models using computer analysis. Machine learning is based on computer algorithms, the most common among them in medicine are the decision tree (DT), naive Bayes classifier (NBC), random forest (RF), support vector machine (SVM), artificial neural network (ANNs), deep neural network (DNN) or deep learning (DL) and convolutional neural network (CNN). Here, we review the main stages of ML, the principles of algorithms action, and the prospects for using AI to predict OH in real-life clinical practice.

Cost analysis of total knee arthroplasty surgeries in Turkey.

While working with increasing costs, hospital enterprises try to develop strategies to provide high quality services. In this study, we intended to perform the cost analysis of total knee arthroplasty. A total of 503 patients who were treated with total knee arthroplasty surgery due to gonarthrosis at Nevşehir State Hospital Orthopedics and Traumatology clinic were included in the study. Procedures performed while the patient is in hospital were analyzed by dividing them into the costs of the implant applied to the patient, surgical procedure, medications used, blood and blood products transfusion, medical tests, anesthesia procedure, bed fee and other applied procedures. The mean total cost was 7560.2 Turkish Lira (TL). The mean cost of the implant applied to the patient was 4847.7 TL, that of surgical procedure was 1800 TL, medications used 371.1 TL, blood and blood products transfusion 38.7 TL, medical tests 38.3 TL, anesthesia procedures 142.7 TL, bed fee 195.2 TL and other applied procedures 122.9 TL. In the cost analyses made in this study, it is observed that the share of implant, surgical procedure and anesthesia costs within the total cost is approximately 90%. It is not possible to cut back on the producedures in this 90% part and to modify them. To reduce the total cost, it seems most reasonable to focus on the costs of blood and blood products transfusion, medical tests, medications used and bed fees.

Evaluation of the relationship between patient blood management and anesthesia method in cesarean section: A single-center study

Objectives: Patient blood management (PBM) aims to improve patient outcome and safety by reducing the quantity of unnecessary blood transfusions and vitalizing patient-specific anemia reserves. We aimed to determine the efficiency and practicality of patient blood management in the cesarean section operating room in our hospital and the effects of the anesthesia method in cesarean section. Methods: Between 2019 and 2021, 6011 patients who underwent cesarean section were reviewed at Bursa City Hospital. Patients who received perioperative or postoperative blood product transfusion were divided into two groups as Group I (n=614) and patients who were not transfused into Group II (n=5397). Demographic data of the patients, preoperative hemogram laboratory values, performed anesthesia methods, transfusion rate were recorded from the database. Results: There was no statistically significant difference between the two groups in terms of demographic data (p&gt;0.05). The preoperative anemia rate was 35.91% (n=2159) and in these patients the blood transfusion rate was 21.86% (n=472). Total transfusion rate was reported as 10.21% (n=614). Preoperative hemoglobin levels were statistically lower in Group I. The spinal anesthesia method was found to be statistically higher in both groups. Conclusion: Patient blood management is very important. In line with the guidelines on this subject, it will reduce unnecessary transfusions and therefore the risks of transfusion complications. In addition, considering the difficulty of supplying blood products, blood transfusion should not be considered primarily as a treatment. Anemia treatment should be planned before surgery and hemoglobin levels should be optimized. It is recommended to prefer regional anesthesia for PBM at cesarean section. In this way, we think that we will both increase the efficiency of patient blood management and reduce the cost and complications of blood transfusion.

The cost-utility of intraoperative tranexamic acid in adult spinal deformity patients undergoing long posterior spinal fusion.

This study aims to evaluate the cost-utility of intraoperative tranexamic acid (TXA) in adult spinal deformity (ASD) patients undergoing long posterior (≥ 5 vertebral levels) spinal fusion. A decision-analysis model was built for a hypothetical 60-year-old adult patient with spinal deformity undergoing long posterior spinal fusion. A comprehensive review of the literature was performed to obtain event probabilities, costs and health utilities at each node. Health utilities were utilized to calculate Quality-Adjusted Life Years (QALYs). A base-case analysis was carried out to obtain the incremental cost and effectiveness of intraoperative TXA. Probabilistic sensitivity analysis was performed to evaluate uncertainty in our model and obtain mean incremental costs, effectiveness, and net monetary benefits. One-way sensitivity analyses were also performed to identify the variables with the most impact on our model. Use of intraoperative TXA was the favored strategy in 88% of the iterations. The mean incremental utility ratio for using intraoperative TXA demonstrated higher benefit and lower cost while being lower than the willingness-to-pay threshold set at $50,000 per quality adjusted life years. Use of intraoperative TXA was associated with a mean incremental net monetary benefit (INMB) of $3743 (95% CI 3492-3995). One-way sensitivity analysis reported cost of blood transfusions due to post-operative anemia to be a major driver of cost-utility analysis. Use of intraoperative TXAs is a cost-effective strategy to reduce overall perioperative costs related to post-operative blood transfusions. Administration of intraoperative TXA should be considered for long fusions in ASD population when not explicitly contra-indicated due to patient factors.

Overcoming the Cost Barrier for Thalassemia Innovative Treatments

Background: It has been estimated that 5-7% of the world's population carries a mutated gene affecting the production or function of the haemoglobin molecule, and that around 56,000 new individuals affected by Thalassemia Dependent Transfusion (TDT) are born every year worldwide. Innovative treatment (IT), such as gene addition therapy (GT), gene editing (GE) and ineffective erythropoiesis modulating drugs (IEMD), have been developing for the cure of TDT patients, offering chances for obtaining durable transfusion independence (TI). The possibility of bringing IT to the “bed-site” of the patient requires sustainable cost for the worldwide health systems. The accessibility to IT may be different according to the private or public organization of the different Country's health systems, this heterogeneity representing one of the main issues to be solved, even in Countries with high gross domestic product like many of those present in Europe. Therefore, the precise definition of the current costs for TDT lifetime treatment in Countries where thalassemia is common is pivotal for the accessibility of IT to the National Health System. Methods: The main aim of this study was to provide an updated information on the current direct cost of TDT patient management, in a region (Sicily, Italy), where there is a Western Public Funded Healthcare System (WPFHS), high incidence of TDT, with well-organized prevention and treatment program, and accurate control of TDT/birth-rate incidence, implemented from 1983 by the Regional Registry on Thalassemia, for assessing the economic impact of well-organized TDT management in a WPFHS. This monocentric study involved adult TDT patients undergoing regular and intensive treatment, at Campus Hematology Franco and Piera Cutino, AOR Villa Sofia-V. Cervello- Palermo (Italy), from 1980 to today. The estimated costs of management of TDT patients included, besides red blood cell transfusions, staff salary, iron chelation with necessary equipment, side-effects monitoring and complications costs (assumed to be equal in Italy, as estimated by Alta Scuola di Economia e Management dei Sistemi Sanitari, Catholic University of the Sacred Heart, Rome, Italy). Results: The summary of results of calculated direct costs for TDT patients management, estimated on 135 patients, are reported on Table I. The overall cost of the lifetime treatment was calculated for the median life (44 years) of TDT patients in Italy, for the 1 st (30.5 years) and 3 rd quartile (53.5years) of our population, respectively. The blood requirement of 2 blood units, with an interval between transfusions of 15 days, was considered as the standard cost for transfusion treatment. Therefore, the transfusion cost for pediatric patients will be less, while a small cohort of adult patients may have higher cost. Table I shows how the cost for managing complications increases with patient age. The direct cost of oral iron chelators, Deferiprone and Deferasirox, was updated, because chelator patents expired (Tab. I). It is noteworthy to underline how, after oral chelators patents expired, DFO is today the most expensive chelation treatment (Tab. I). The social cost and those related to the loss of working days was not calculated in this study. The three estimation costs may be useful for comparing cost of TDT according to the variation of the median life among different Countries.Conclusion: The cost of TDT patient in WPFHS decreased over the last years, because of the oral iron chelator patents expiring. This cost changes according to age, because of the different incidence of complications, increasing from € 1.035.422,49 (30.5 years) to € 1.816.232,89 (53,5 years)with a median life cost of € 1.493.724,24.These data support the concept that any kind of IT has to be offered at competitive cost in comparison with that of conventional treatment. Finally, considering the permanence of “uncertainty area” for the sustained patient benefit, a reimbursement based on the “pay at result” approach should be considered.

The cost-effectiveness of tranexamic acid for preventing blood transfusions following reverse total shoulder arthroplasty: a break-even analysis

BackgroundThe administration of tranexamic acid (TXA) in patients undergoing shoulder arthroplasty is a safe and effective means of reducing blood loss and blood transfusions. Due to its low cost and ability to prevent costly complications, TXA’s use is thought to be a cost-saving practice. The purpose of this study was to determine the cost-effectiveness of TXA in preventing blood transfusions in patients undergoing reverse shoulder arthroplasty (RSA). MethodsThe cost of TXA ($5.22) and the cost of a blood transfusion ($299.31) from our institution, as well as baseline published blood transfusion rates following RSA (14.3%) without the administration of TXA, were included in a break-even model to calculate the absolute risk reduction (ARR) that the routine use of TXA would need to be considered economically justifiable. To account for variance in baseline transfusion rates, the cost of TXA, and the cost of blood transfusion across institutions, sensitivity analyses were conducted in which the break-even transfusion rate and ARR were calculated across a wide range for each variable. ResultsTXA is deemed cost-effective if it prevents one blood transfusion out of 57 RSAs (ARR = 1.74%). It is economically viable at varying drug costs ($1-$25), blood transfusion costs ($50-$5000), and baseline transfusion rates (2.00%-50.00%). ConclusionUsing the cost parameters at a single institution, the current study found that TXA would be cost-effective in preventing blood transfusion if its routine use achieves an ARR greater than 1.74% following RSA. As the ARR has been demonstrated in the literature to be greater than 1.74%, TXA can be considered cost-effective in preventing blood transfusion following RSA.

Estimating Transfusion-Related Medical Costs and Associated Time Burden in Patients with Myelofibrosis: A Comparison of Momelotinib Vs Ruxolitinib Based on Simplify-1

Introduction: Myelofibrosis (MF) is a myeloproliferative neoplasm characterized by splenomegaly, debilitating symptoms, and bone marrow fibrosis. Transfusion-dependent (TD) anemia is present in one-quarter of patients (pts) with MF at diagnosis and becomes more common over time. Transfusion dependence imposes a high cost burden on healthcare systems, with annual total medical costs up to 9 times higher for TD pts than for non-TD pts (Gerds A, et al. ASH 2022. Abstract 1729). Momelotinib (MMB) is a Janus kinase (JAK) 1/JAK2/activin A receptor type 1 inhibitor that has demonstrated symptom, spleen, and anemia benefits in pts with MF across 3 phase 3 trials. Evidence in JAK inhibitor-naive pts comes from SIMPLIFY-1 (NCT01969838), a randomized, double-blind, phase 3 trial of MMB vs ruxolitinib (RUX). Eligible pts had International Prognostic Scoring System high-risk or intermediate-2-risk MF, or intermediate-1-risk MF associated with symptomatic splenomegaly, hepatomegaly, or anemia (hemoglobin &amp;lt;10 g/dL) and/or unresponsiveness to available non-JAK inhibitor therapy. MMB was associated with higher red blood cell (RBC) transfusion independence rates (66.5% vs 49.3%), lower transfusion dependence rates (30.2% vs 40.1%), and fewer RBC units transfused (median of zero units/month vs 0.4 units/month) compared with RUX by week 24. This study estimated the projected differences between MMB and RUX in total medical costs as well as cost and time burden associated with outpatient transfusion visits, based on results from SIMPLIFY-1, in all pts with MF and separately in those aged ≥65 years. Methods: Analyses were based on transfusion status (TD, transfusion independent [TI], or transfusion requiring [TR]) and mean rates of outpatient transfusion visits over 24 weeks in SIMPLIFY-1. TD was defined as ≥4 RBC units transfused or hemoglobin &amp;lt;8 g/dL in the prior 8 weeks, TI was defined as no RBC transfusions and all hemoglobin ≥8 g/dL in the prior 12 weeks, and TR was defined as being neither TD nor TI. Projected cost offsets for MMB relative to RUX were calculated based on observed transfusion status and rates over 24 weeks from SIMPLIFY-1 combined with cost estimates for TD vs TI/TR from the IBM MarketScan Database used to inform commercial health plans. Projected time savings were calculated similarly using transfusion rates from SIMPLIFY-1 and previously reported time burden estimates for transfusion visits in pts with TD β-thalassemia (Knoth RL, et al. EHA2022. Poster P1741). For pts aged ≥65 years, individual pt data from SIMPLIFY-1 and cost estimates from the Medicare fee-for-service database were used instead. Results: Based on the IBM MarketScan Commercial Database, projected average annual total medical cost savings based on week 24 transfusion status with MMB vs RUX were $20,215 per pt with baseline TD status and $23,991 per pt with baseline TI/TR status. Fewer outpatient transfusion visits with MMB vs RUX resulted in projected annual savings of $25,704 per pt with baseline TD status and $12,083 per pt with baseline TI/TR status. Among pts with baseline TD status, projected annual time savings in transfusion visits for MMB vs RUX (147 vs 253 hours) totaled 106 hours per pt (42 hours, preparation and waiting; 50 hours, transfusion and recovery; 15 hours, travel), a 42% reduction for MMB vs RUX. In the subgroup analysis that focused on pts aged ≥65 years, based on the Medicare fee-for-service database, projected average annual total medical cost savings with MMB vs RUX were $11,102 per pt with baseline TD status and $17,373 per pt with baseline TI/TR status. Fewer outpatient transfusion visits with MMB vs RUX resulted in projected annual savings of $28,826 per pt with baseline TD status and $18,255 per pt with baseline TI/TR status. Among pts aged ≥65 years with baseline TD status, projected annual time savings in transfusion visits accounted for MMB vs RUX (160 vs 279 hours) totaled 119 hours per pt (47 hours, preparation and waiting; 56 hours, transfusion and recovery; 16 hours, travel), a 43% reduction for MMB vs RUX. Conclusions: Reductions in transfusion dependence and transfusion visits for MMB vs RUX were associated with projected healthcare system savings in transfusion costs and transfusion-related time burden in JAK inhibitor-naive pts with MF, including in subgroup analyses of pts aged ≥65 years.

Blood's Hidden Price Tag: A Comprehensive Analysis of Transfusion Economics and the Inherent Valuation Challenges with Blood

Introduction: In the juxtaposition of a bustling hospital and a serene blood donation center, the duality of blood is unveiled. For the donor, it may symbolize an act of selfless giving, a priceless offering freely bestowed. For the patient in dire need, it assumes the status of a vital life force, with a value transcending conventional calculation akin to the rarest of treasures. This dichotomy, where blood stands at the crossroads of human generosity and life's essential currency, opens a pathway for an intricate and profound investigation into both the economic and philosophical appraisals of this indispensable resource. Blood is an essential life-sustaining resource transcending conventional commodity status. Donated voluntarily, its valuation cannot merely adhere to supply and demand principles but must align with ethical and social considerations. The notion of compensation for blood donation harbors inherent contradictions and forms an ongoing international debate. In some jurisdictions, monetary incentives for blood donations are strictly prohibited and illegal, such as Brazil and Australia. In others, like the United States (with the exception of California) payment for blood is not illegal, however many hospitals chose not to use paid donor's blood due to safety concerns. Major regulatory bodies like The World Health Organization (WHO) and the Food and Drug Administration (FDA) firmly discourage payment for blood donations. This study dissects the multifaceted financial dimensions of blood transfusions, establishing the groundwork for assessing a potential compensation program for blood donors and delineating the numerous stakeholders whose interests intertwine with the precise monetary valuation of blood. Methods: We undertook a meticulous analysis of publicly available financial expenditures associated with blood transfusion, drawing from data provided by insurance entities, hospitals, blood banks, and donation programs. Through a visually illustrative chart and graph, we mapped out the complexities inherent in the financial breakdown. We delineated the many variables, and further researched into current compensation or incentives provided by blood drives, investigating how these align with our complex financial findings. Results: Our granular financial analysis revealed that costs were allocated across collection fees (7.1%), processing (14.3%), testing (21.4%), storage (10.7%), distribution (14.3%), and transfusion (32.2%). A notable disparity emerged between urban and rural costs, with the latter displaying up to 20% lower expenses. Insurance claim markups ranged from 25% to 50%. On a philosophical level, tensions between blood commodification and social good perspectives surfaced. We found that most U.S. blood drives abstained from financial incentives, instead offering non-monetary rewards. The variability in cost and ethical considerations were surmised to contribute to this trend. Conclusions: Our research underscores the rationale behind WHO and FDA advisements against compensation for blood donation, citing safety, ethics, and complexity. As our visual tools exhibit, blood transfusions are financially multifaceted, interweaving variables like market demands, transportation, storage, and hospital fees. The entanglement of financial complexity with profound ethical and social dilemmas creates an unparalleled challenge in attributing a precise monetary value to blood. Such an endeavor would necessitate an unprecedented level of accuracy to preclude potential exploitation by stakeholders. The observed variability in transfusion costs alone substantiates the near-impossibility of monetizing blood, reaffirming the necessity for ongoing dialogue and exploration if we are to ever truly reveal blood's hidden price tag.

A cost-effectiveness analysis of intraoperative autologous transfusion in adolescent idiopathic scoliosis surgery: a single-centre retrospective study

BackgroundIntraoperative autologous transfusion (IAT) has been used in scoliosis surgery for decades; however, its cost-effectiveness remains debatable. This study aimed to evaluate the cost-effectiveness of IAT in adolescent idiopathic scoliosis (AIS) surgery and identify risk factors of massive intraoperative blood during this surgery.MethodsThe medical records of 402 patients who underwent AIS surgery were reviewed. The patients were divided into different groups according to the intraoperative blood loss volume (group A: ≥500 to < 1000 mL, B: ≥1,000 to < 1,500 mL, and C: ≥1,500 mL) and whether IAT was used (i.e., IAT and no-IAT groups). The volume of blood loss, volume of transfused allogeneic red blood cells (RBC), and RBC transfusion costs were analysed. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors of massive intraoperative blood loss (≥ 1,000 mL and ≥ 1,500 mL). A receiver operating characteristic (ROC) curve was used to analyse the cut-off values of the factors contributing to massive intraoperative blood loss.ResultsIn group A, no significant difference was observed in the volume of allogeneic RBC transfused during and after procedure between the IAT and no-IAT groups; however, total RBC transfusion costs was significantly higher in the IAT group. In groups B and C, the patients in the IAT group compared with those in the no-IAT group had a lower volume of allogeneic RBC transfused during the operation and on the first day after the operation. However, in group B, the total RBC transfusion cost in the patients who used IAT was significantly higher. In group C, total RBC transfusion cost in the patients who used IAT was significantly lower. The number of fused vertebral levels and Ponte osteotomy were found to be independent risk factors for massive intraoperative blood loss. ROC analysis showed that more than eight and 10 fused vertebral levels predicted ≥ 1,000 mL and ≥ 1,500 mL intraoperative blood loss, respectively.ConclusionThe cost-effectiveness of IAT in AIS was related to the volume of blood loss, and when the blood loss volume was ≥ 1,500 mL, IAT was cost-effective, drastically reducing the demand for allogeneic RBC and total RBC transfusion cost. The number of fused vertebral levels and Ponte osteotomy were independent risk factors for massive intraoperative blood loss.

High Hospital-related Costs at the End-of-life in Patients With Multiple Myeloma: A Single-center Study.

High Hospital-related Costs at the End-of-life in Patients With Multiple Myeloma: A Single-center Study.

Clinical application of a modified predeposit autologous red blood cell apheresis in multistage spinal fusion: a single-center retrospective study.

This study aimed to evaluate the efficacy and safety of predeposit autologous RBC apheresis (PARA) in patients undergoing multilevel spinal fusion surgery. A total of 112 patients from January 2020 to June 2022 were divided into two groups according to PARA: the PARA group (n = 51) and the control group (n = 61). The baseline characteristics of the patients, outcomes, transfusion cost, hospitalization cost, length of stay, complications, and changes in hemoglobin and hematocrit levels between the two groups were compared. The baseline characteristics were similar in both groups. No significant differences were found in functional outcomes, including VAS score (p = 0.159), ODI score (p = 0.214), JOA score (p = 0.752), and SF-36 score (p = 0.188) between the PARA and control groups. The amount and rate of intraoperative and perioperative allogeneic RBC transfusion were significantly higher in the control group than in the PARA group (p < 0.001). The postoperative (9.04 ± 3.21 vs. 11.05 ± 3.84, p = 0.004) and total length of stay (15.78 ± 3.79 vs. 17.36 ± 4.08, p = 0.038) in the PARA group were significantly lower than those in the control group, respectively. Despite no difference in hospitalization cost (p = 0.737), the total blood transfusion cost in the PARA group was significantly lower, compared with the control group (p < 0.001). For safety evaluation, there were no significant differences in Hb and Hct levels between the two groups at admission, on postoperative day 1, and postoperative day 3, respectively (p > 0.05). Moreover, the number of postoperative infections in the PARA group was significantly lower than that in the control group (p = 0.038). PARA was a novel, safe, and highly efficient technique for mass autologous blood preparation in a quite short preparation time. This method could significantly reduce the amount of allogeneic blood transfusion and length of stay, which could provide a theoretical basis for following clinical practice about the technique.

5567917 COST COMPARISON OF TRANSFUSION CHOICES IN OMAN FOR PATIENTS SUFFERING FROM SICKLE CELL DISEASE

Background: Sickle cell disease(SCD) management can be challenging, requiring different therapeutic approaches because SCD could induce multiple complications. Red blood cell(RBC) transfusion is well known as one of the disease-modifying therapies available for long-term management. It’s supported by multiple randomized clinical trials for the prevention of disease complications such as stroke in adults and children with SCD.RBCs can be delivered via three methods: Simple transfusion(ST), manual exchange(ME) and automated red blood cell exchange(aRBCX). In ST, patients receive additional units of blood. The purpose is to raise the haemoglobin (Hb) to a steady state and maintain the oxygen-carrying capacity of blood. ME transfusion consists of removing the patient’s sickle-shaped RBCs and replacing them with healthy ones— lowering the concentration of sickled cells without increasing blood viscosity. This is performed using repeated alternating isovolumetric phlebotomy and blood transfusion. aRBCX involves removing sickled RBCs from the patient and rapid replacement with healthy RBCs while maintaining isovolemia. An advantage of aRBCX is the avoidance or minimization of costly iron chelation therapy to treat iron overload. Aim: SCD management is an important cost driver for health systems. The intent of this research was to compare the cost-effectiveness of different transfusion modalities. We wanted to compare the all-inclusive costs. and wanted to perform this evaluation in Oman, as the incidence of SCD ranges between 0.2% and 0.07%. This disease is considered one of Oman’s most common genetic blood disorders. Method: In-depth data about variables that drive costs have been collected to populate a de novo cost model. We collected data from the Royal Hospital and Sultan Qaboos University Hospital. Cost drivers that we took into consideration were disease incidence, cost of blood transfusion, medical equipment, disposables, cost of staff, complications, iron chelation therapy, hospitalization, and lives lost. The assessment took place in June 2020. The cost of the treatment intervention, cost of disease-related complications and the yearly cost of treatment imputable to each transfusion modality represented the most significant differences across the three transfusion choices. By populating the model with resources provided by the two above-mentioned hospitals, we could demonstrate the cost differences between transfusion choices and the potential benefits that healthcare providers can experience. The results demonstrate significant differences across cost parameters, such as Cost of treatment, Cost of treatment-related potential effect, Cost of complications, Cost of life years lost, and Estimated total yearly cost per patient. Results and conclusion: aRBCX promotes a reduction in overall resource utilization and improved patient outcomes. aRBCX is approximately 47% less costly than ST, and is approximately 23% less costly when compared to ME. By highlighting the consequence of treatment choice and its financial impact, we aim to support the adoption of aRBCX in comparison to alternative transfusion choices and validate future reimbursement considerations. aRBCX cost savings may lead to better adoption. We recommend researchers rerun these calculations with the model on an individual hospital basis.

Thalassemia care in Nepal: In dire need of improvement.

Thalassemia care in Nepal: In dire need of improvement.

Cost-effectiveness of Fibrinogen Concentrate vs Cryoprecipitate for Treating Acquired Hypofibrinogenemia in Bleeding Adult Cardiac Surgical Patients

Excessive bleeding requiring fibrinogen replacement is a serious complication of cardiac surgery. However, the relative cost-effectiveness of the 2 available therapies-fibrinogen concentrate and cryoprecipitate-is unknown. To determine cost-effectiveness of fibrinogen concentrate vs cryoprecipitate for managing active bleeding in adult patients who underwent cardiac surgery. A within-trial economic evaluation of the Fibrinogen Replenishment in Surgery (FIBERS) randomized clinical trial (February 2017 to November 2018) that took place at 4 hospitals based in Ontario, Canada, hospitals examined all in-hospital resource utilization costs and allogeneic blood product (ABP) transfusion costs incurred within 28 days of surgery. Participants included a subset of 495 adult patients from the FIBERS trial who underwent cardiac surgery and developed active bleeding and acquired hypofibrinogenemia requiring fibrinogen replacement. Fibrinogen concentrate (4 g per dose) or cryoprecipitate (10 units per dose) randomized (1:1) up to 24 hours postcardiopulmonary bypass. Effectiveness outcomes included number of ABPs administered within 24 hours and 7 days of cardiopulmonary bypass. ABP transfusion (7-day) and in-hospital resource utilization (28-day) costs were evaluated and a multivariable net benefit regression model built for the full sample and predefined subgroups. Patient level costs for 495 patients were evaluated (mean [SD] age 59.2 [15.4] years and 69.3% male.) Consistent with FIBERS, ABP transfusions and adverse events were similar in both treatment groups. Median (IQR) total 7-day ABP cost was CAD $2280 (US dollars [USD] $1697) (CAD $930 [USD $692]-CAD $4970 [USD $3701]) in the fibrinogen concentrate group and CAD $2770 (USD $1690) (IQR, CAD $1140 [USD $849]-CAD $5000 [USD $3723]) in the cryoprecipitate group. Median (interquartile range) total 28-day cost was CAD $38 180 (USD $28 431) $(IQR, CAD $26 350 [USD $19 622]-CAD $65 080 [USD $48 463]) in the fibrinogen concentrate group and CAD $38 790 (USD $28 886) (IQR, CAD $26 180 [USD $19 495]-CAD $70 380 [USD $52 409]) in the cryoprecipitate group. After exclusion of patients who were critically ill before surgery (11%) due to substantial variability in costs, the incremental net benefit of fibrinogen concentrate vs cryoprecipitate was positive (probability of being cost-effective 86% and 97% at $0 and CAD $2000 (USD $1489) willingness-to-pay, respectively). Net benefit was highly uncertain for nonelective and patients with critical illness. Fibrinogen concentrate is cost-effective when compared with cryoprecipitate in most bleeding adult patients who underwent cardiac surgery with acquired hypofibrinogenemia requiring fibrinogen replacement. The generalizability of these findings outside the Canadian health system needs to be verified.

New horizons for reduction of blood use: Patient blood management.

A countrywide study over the eras indicates overuse of blood transfusion can have considerable risks to patients accompanied by significant costs of blood transfusion for patients, hospitals, and health-care systems. Besides, more than 30% of the world's population is anemic. Typically, blood transfusion helps continue suitable oxygen transfer in anemia, i.e., more and more documented as a threatening factor with several adverse outcomes including long hospitalization, morbidity, and mortality. Transplantation of allogeneic blood is thus like a two-edged sword. There is no doubt that the blood transfusion is a life-saving treatment, but it should be underpinned by much of up-to-date health-care services. The new theory considered for patient blood management (PBM) also discusses the timely application of evidence-based surgical and clinical theories and focuses on patient outcomes. Furthermore, PBM involves a multidisciplinary methodology to reduce unnecessary transfusions, minimize costs, and cut risks.