[Budget impact analysis of a blood saving program for urgent traumatological surgery].
OBJECTIVE
To assess the cost-effectiveness and the budget impact of a Blood Saving Program (BSP) in patients older than 65 undergoing perthrocanteric hip fracture surgery.


METHODS
Two groups of patients with perthrocanteric fracture were included. Group 1: patients not receiving treatment for perisurgical anaemia or treated with oral iron; Group 2: patients included in a BSP (treatment with endovenous iron sucrose and alfa epoetin, plus restrictive transfusional criteria). Effectiveness issues were: transfusion rate and number of red blood cell units transfused, length of postoperative stay and infection rate. Treatment cost was calculated using drug and transfused red blood cell unit prizes in 2003. We calculated potential patient population according to 2003 data.


RESULTS
144 patients were included, 43 of which were in the BSP. Both groups were comparable in gender, age, preoperative length of stay, ASA and haemoglobin level at admission. Patients included in the BSP were less transfused and had less infections but postoperative stay was similar in both groups. The budget impact was 239,148 euros 95% [confidence interval (CI) 202,312-311,980] at group 1 and 311,980 euros [95% CI 275,288-348,672] at the BSP group. Including the whole potential population in the BSP (during one year 400 patients) would mean a cost increase of 72,832 euros, avoiding transfusion in 92 patients, infection in 70 patients, and saving 328 red blood cell units.


CONCLUSIONS
The cost increase due to endovenous iron sucrose and alfa-epoetin can be considered affordable for the hospital budget. BSP provides lower transfusion and infection rates and saves red blood cell units, compared to the standard procedure. Differences in postoperative stay should be analyzed in further larger and prospective studies including more patients.
Izuel Rami
Mónica
M
Servicio de Farmacia Hospitalaria, Hospital Universitario Miguel Servet, P. Isabel La Católica 1-3, 50009 Zaragoza, Spain.
Gómez Barrera
Manuel
M
Villar Fernández
Isabel
I
Rabanaque Hernández
María José
MJ
Cuenca Espiérrez
Jorge
J
García-Erce
José Antonio
JA
D000284:Administration, Oral; D000367:Age Factors; D000369:Aged, 80 and over; D000740:Anemia / Q000188:drug therapy / Q000191:economics* / Q000209:etiology / Q000628:therapy*; D002017:Budgets; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003627:Data Interpretation, Statistical; D000068817:Epoetin Alfa; D017707:Erythrocyte Transfusion / Q000191:economics*; D004921:Erythropoietin / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid; D006397:Hematinics / Q000008:administration & dosage / Q000627:therapeutic use; D006620:Hip Fractures / Q000191:economics* / Q000601:surgery*; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D011994:Recombinant Proteins
D005290:Ferric Compounds; D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa; D007501:Iron; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid