Economic evaluation of high-dose and low-dose aprotinin therapy during cardiopulmonary bypass.
BACKGROUND
Aprotinin therapy is now widely used during cardiac surgery. This study examined the clinical and economic effectiveness of high-dose or low-dose aprotinin in comparison to placebo.


METHODS
In a double blind, randomized study, three groups of 50 patients received high-dose aprotinin costing AUS$614 per patient (AUS$ = Australian dollars), low-dose aprotinin costing AUS$220 per patient or placebo. Resource use influenced by aprotinin therapy was measured.


RESULTS
Both doses were effective in reducing chest drainage and postoperative transfusion requirements, high-dose being more effective than low-dose. Both doses reduced the rate of reoperations for hemostasis. A base case of statistically significant differences associated with the high-dose and low-dose aprotinin showed cost savings of AUS$77 and AUS$348 per patient, respectively. If the demonstrated less significant reductions in operating room and ward stay are included, these savings become AUS$463 and AUS$715, respectively. Alternately, if cross-matches are replaced by group-and-hold and cell savers are not used, the savings per patient would be AUS$196 and AUS$467, respectively.


CONCLUSIONS
While high-dose aprotinin is clinically more effective than low-dose aprotinin, low-dose therapy demonstrates greater cost savings.
Ray
M J
MJ
Department of Haematology, The Prince Charles Hospital, Brisbane, Deakin University, Victoria, Australia. mjray@bit.net.au
Brown
K F
KF
Burrows
C A
CA
O'Brien
M F
MF
D007611:Aprotinin / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D001315:Australia; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000191:economics; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D006351:Heart Valves / Q000601:surgery; D006490:Hemostatics / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D006801:Humans
D006490:Hemostatics; D007611:Aprotinin