title: Cost-minimization analysis of two fluid products for resuscitation of critically injured trauma patients.
abstract: OBJECTIVE
  Results of a study to determine potential cost benefits of substituting an alternative electrolyte solution for 0.9% sodium chloride injection for the initial fluid resuscitation of trauma patients are presented.
  
  
  METHODS
  Using data from a randomized clinical trial that compared 24-hour fluid resuscitation outcomes in critically injured trauma patients treated with 0.9% sodium chloride injection and those who received a balanced electrolyte solution (Plasma-Lyte A, Baxter Healthcare), a cost-minimization analysis was performed at a large medical center. The outcomes evaluated included fluid and drug acquisition costs, materials and nurse labor costs, and costs associated with electrolyte replacement.
  
  
  RESULTS
  The use of Plasma-Lyte A was associated with a relatively higher fluid acquisition cost but a reduced need for magnesium replacement. During the first 24 hours of hospitalization, 4 of 24 patients (17%) treated with 0.9% sodium chloride injection and none of the patients who received the comparator product (n = 22) required supplemental magnesium. Patients treated with 0.9% sodium chloride injection received a median of 4 g of magnesium (interquartile range [IQR], 2.5-4.0 g), compared with a median of 0 g (IQR 0-2 g) in the comparator group. Taking into account the costs of consumable supplies and nursing labor, the cost-minimization analysis indicated a 24-hour cost differential of $12.35 in favor of Plasma-Lyte A.
  
  
  CONCLUSIONS
  Substitution of Plasma-Lyte A for 0.9% sodium chloride injection for fluid resuscitation during the first 24 hours after traumatic injury was associated with decreased magnesium replacement requirements and a net cost benefit to the institution.
authors.affiliation: Caitlin A. Smith, M.D., is General Surgery Resident; Jeremiah J. Duby, Pharm.D., is Assistant Clinical Professor of Pharmacy; Garth H. Utter, M.D., M.Sc., is Associate Professor of Surgery; Joseph M. Galante, M.D., is Assistant Professor of Surgery; Lynette A. Scherer, M.D., is Professor of Surgery; and Carol R. Schermer, M.D., M.P.H., is Professor of Surgery, Department of Surgery, Division of Trauma and Emergency Surgery, and Department of Pharmacy, University of California, Davis, Medical Center, Sacramento.
authors.forename: Caitlin A
authors.initials: CA
authors.lastname: Smith
authors.forename: Jeremiah J
authors.initials: JJ
authors.lastname: Duby
authors.forename: Garth H
authors.initials: GH
authors.lastname: Utter
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Galante
authors.forename: Lynette A
authors.initials: LA
authors.lastname: Scherer
authors.forename: Carol R
authors.initials: CR
authors.lastname: Schermer
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D016638:Critical Illness / Q000191:economics* / Q000628:therapy; D004311:Double-Blind Method; D004573:Electrolytes / Q000008:administration & dosage / Q000191:economics*; D005260:Female; D005440:Fluid Therapy / Q000191:economics* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000191:economics*; D012151:Resuscitation / Q000191:economics* / Q000379:methods; D012462:Saline Solution, Hypertonic; D014947:Wounds and Injuries / Q000191:economics* / Q000628:therapy; D055815:Young Adult
chemical_list: D004573:Electrolytes; D010952:Plasma Substitutes; D012462:Saline Solution, Hypertonic; C048013:Plasmalyte A