Association between bleeding, blood transfusion, and costs among patients with non-ST-segment elevation acute coronary syndromes.
BACKGROUND
Bleeding and blood transfusion are associated with increased morbidity and mortality among patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS); however, the economic consequences of these complications are not well defined. We sought to determine the relationship between bleeding, blood transfusion, and measures of costs among patients with non-ST-segment elevation ACS.


METHODS
We analyzed data from the economic substudy of the GUSTO IIb trial (n = 1235) to determine the relationship between bleeding; transfusion; and hospital costs, physician costs, total costs, and length of stay. Linear regression models were developed to determine the cost implications of each bleeding and transfusion event.


RESULTS
Of the patients in the economic substudy of GUSTO IIb, 36.8% (n = 455) experienced a bleeding event. As bleeding severity increased, there was a stepwise increase in length of stay (no bleeding 5.4 days, mild bleeding 6.9 days, moderate bleeding 15.0 days, severe bleeding 16.4 days; P < .01) and unadjusted total costs (no bleeding $14,282, mild $21,674, moderate $45,798, severe $66,564; P < .01). After adjustment for baseline differences among patients, each moderate or severe bleeding event increased costs by $3770 and each transfusion event increased costs by $2080. Further modeling demonstrated that the increase in costs was driven by increases in length of stay.


CONCLUSIONS
Bleeding and transfusion are associated with increased resource use among patients with NSTE ACS. These data suggest that strategies that reduce both ischemia and the risk for bleeding have the potential to produce important reductions in the costs of care for patients with NSTE ACS.
Rao
Sunil V
SV
The Duke Clinical Research Institute, Durham, NC 27705, USA. sunil.rao@duke.edu
Kaul
Padma R
PR
Liao
Lawrence
L
Armstrong
Paul W
PW
Ohman
E Magnus
EM
Granger
Christopher B
CB
Califf
Robert M
RM
Harrington
Robert A
RA
Eisenstein
Eric L
EL
Mark
Daniel B
DB
D054058:Acute Coronary Syndrome / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D000328:Adult; D000368:Aged; D001803:Blood Transfusion / Q000191:economics*; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D017048:Health Care Costs; D006401:Hematologic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006470:Hemorrhage / Q000139:chemically induced / Q000191:economics* / Q000628:therapy; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D006401:Hematologic Agents; D010975:Platelet Aggregation Inhibitors