title: Activity-based costs of blood transfusions in surgical patients at four hospitals.
abstract: BACKGROUND
  Blood utilization has long been suspected to consume more health care resources than previously reported. Incomplete accounting for blood costs has the potential to misdirect programmatic decision making by health care systems. Determining the cost of supplying patients with blood transfusions requires an in-depth examination of the complex array of activities surrounding the decision to transfuse.
  
  
  METHODS
  To accurately determine the cost of blood in a surgical population from a health system perspective, an activity-based costing (ABC) model was constructed. Tasks and resource consumption (materials, labor, third-party services, capital) related to blood administration were identified prospectively at two US and two European hospitals. Process frequency (i.e., usage) data were captured retrospectively from each hospital and used to populate the ABC model.
  
  
  RESULTS
  All major process steps, staff, and consumables to provide red blood cell (RBC) transfusions to surgical patients, including usage frequencies, and direct and indirect overhead costs contributed to per-RBC-unit costs between $522 and $1183 (mean, $761 +/- $294). These exceed previously reported estimates and were 3.2- to 4.8-fold higher than blood product acquisition costs. Annual expenditures on blood and transfusion-related activities, limited to surgical patients, ranged from $1.62 to $6.03 million per hospital and were largely related to the transfusion rate.
  
  
  CONCLUSIONS
  Applicable to various hospital practices, the ABC model confirms that blood costs have been underestimated and that they are geographically variable and identifies opportunities for cost containment. Studies to determine whether more stringent control of blood utilization improves health care utilization and quality, and further reduces costs, are warranted.
authors.affiliation: The Institute for Patient Blood Management and Bloodless Medicine at Englewood Hospital and Medical Center, Englewood, New Jersey, USA. aryeh.shander@ehmc.com
authors.forename: Aryeh
authors.initials: A
authors.lastname: Shander
authors.forename: Axel
authors.initials: A
authors.lastname: Hofmann
authors.forename: Sherri
authors.initials: S
authors.lastname: Ozawa
authors.forename: Oliver M
authors.initials: OM
authors.lastname: Theusinger
authors.forename: Hans
authors.initials: H
authors.lastname: Gombotz
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
mesh_terms: D001793:Blood Preservation / Q000191:economics / Q000379:methods; D001803:Blood Transfusion / Q000191:economics* / Q000706:statistics & numerical data; D003363:Cost Control; D004469:Economics, Hospital / Q000706:statistics & numerical data; D017707:Erythrocyte Transfusion / Q000191:economics* / Q000706:statistics & numerical data; D005060:Europe; D006801:Humans; D007258:Informed Consent; D012984:Software / Q000191:economics; D013514:Surgical Procedures, Operative / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States