Cost/benefit analysis of pharmacologic hemostasis.
BACKGROUND
Surgical bleeding with possible associated coagulopathies is a major source of morbidity and mortality. More than 27% of patients receive unnecessary blood or blood-product transfusions during cardiac operations. Analysis of the cost-benefit of pharmacologic hemostasis can be accomplished by relating all the components of cost, which include both direct and indirect costs to both direct and indirect benefits to the patient.


METHODS
A significant reduction in transfusion requirements can be achieved by the systematic application of a clinical algorithm. An alternative is to use drugs that enhance hemostasis. Four such drugs commonly used are desmopressin acetate, tranexamic acid, epsilon-aminocaproic acid, and aprotinin. All these agents have been shown to successfully reduce bleeding and the need for transfusion. It appears that the order of efficacy (greatest to least) is aprotinin, tranexamic acid, epsilon-aminocaproic acid, and desmopressin acetate.


RESULTS
Cost/benefit analysis associated with the use of these agents is complex. The direct costs of these drug treatments can be balanced against the costs related to blood and blood-product administration. Using epsilon-aminocaproic acid, blood used is valued at $30, whereas the drug treatment cost is less than $2. Aprotinin use results in costs of more than $500, with the drug costing $900.


CONCLUSIONS
Improved hemostasis should also result in indirect cost savings from reduced operating room time, reduced intensive care unit and hospital stay, and the avoidance of reoperation for bleeding.
Harmon
D E
DE
Department of Cardiovascular and Transplant Anesthesia, Alton Ochsner Clinic, New Orleans, Louisiana 70121, USA.
D015119:Aminocaproic Acid / Q000191:economics / Q000627:therapeutic use; D007611:Aprotinin / Q000191:economics* / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D001026:Coronary Artery Bypass / Q000191:economics*; D003362:Cost-Benefit Analysis; D003894:Deamino Arginine Vasopressin / Q000191:economics / Q000627:therapeutic use; D006488:Hemostasis, Surgical / Q000191:economics* / Q000379:methods; D006490:Hemostatics / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D012086:Reoperation; D014148:Tranexamic Acid / Q000191:economics / Q000627:therapeutic use
D006490:Hemostatics; D014148:Tranexamic Acid; D007611:Aprotinin; D003894:Deamino Arginine Vasopressin; D015119:Aminocaproic Acid