title: Cost analysis of re-exploration for bleeding after coronary artery bypass graft surgery.
abstract: BACKGROUND
  Re-exploration for bleeding after cardiac surgery is an indicator of substantial haemorrhage and is associated with increased hospital resource utilization. This study aimed to analyse the costs of re-exploration and estimate the costs of haemostatic prophylaxis.
  
  
  METHODS
  A total of 4232 patients underwent isolated, first-time, coronary artery bypass graft (CABG) surgery during 2005-8. Each patient re-explored for bleeding (n=127) was matched with two controls not requiring re-exploration (n=254). Cost analysis was based on resource utilization from completion of CABG until discharge. A mean cost per patient for re-exploration was calculated. Based on this, the net cost of prophylactic treatment with haemostatic drugs for preventing re-exploration was calculated.
  
  
  RESULTS
  Patients undergoing re-exploration had higher exposure to clopidogrel before operation, prolonged stays in the intensive care unit, and more blood transfusions than controls. The mean incremental cost for re-exploration was €6290 [95% confidence interval (CI) €3408-€9173] per patient, of which 48% [€3001 (95% CI €249-€2147)] was due to prolonged stay, 31% [€1928 (95% CI €1710-€2147)] to the cost of surgery/anaesthesia, 20% [€1261 (95% CI €1145-€1378)] to the increased number of blood transfusions, and <2% [€100 (95% CI €39-€161)] to the cost of haemostatic drugs. A cost model, at an estimated 50% efficacy for recombinant activated clotting factor VIIa and a 50% expected risk for re-exploration without prophylaxis, demonstrated that to be cost neutral, prophylaxis of four patients needed to result in one avoided re-exploration.
  
  
  CONCLUSIONS
  The resource utilization costs were substantially higher in patients requiring re-exploration for bleeding. From a strict cost-effectiveness perspective, clinical interventions to prevent haemorrhage might be underutilized.
authors: Department of Cardiothoracic Surgery and Anaesthesia, Uppsala University Hospital, Uppsala, Sweden. u.a@surgsci.uu.se
authors: U
authors: U
authors: Alström
authors: L-Å
authors: LÅ
authors: Levin
authors: E
authors: E
authors: Ståhle
authors: R
authors: R
authors: Svedjeholm
authors: O
authors: O
authors: Friberg
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000191:economics*; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D015942:Factor VIIa / Q000191:economics / Q000627:therapeutic use; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006488:Hemostasis, Surgical / Q000191:economics / Q000379:methods; D006490:Hemostatics / Q000191:economics / Q000627:therapeutic use; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D019106:Postoperative Hemorrhage / Q000191:economics* / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D012086:Reoperation / Q000191:economics; D013548:Sweden; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa