title: Hospital economic impact from hemostatic matrix usage in cardiac surgery.
abstract: OBJECTIVE
  Improved health outcomes can result in economic savings for hospitals and payers. While effectiveness of topical hemostatic agents in cardiac surgery has been demonstrated, evaluations of their economic benefit are limited. This study quantifies the cost consequences to hospitals, based on clinical outcomes, from using a flowable hemostatic matrix vs non-flowable topical hemostatic agents in cardiac surgery.
  
  
  METHODS
  Applying clinical outcomes from a prospective randomized clinical trial, a cost consequence framework was utilized to model the economic impact of comparator groups. From that study, clinical outcomes were obtained and analyzed for a flowable hemostatic matrix (FLOSEAL, Baxter Healthcare Corporation) vs non-flowable topical hemostats (SURGICEL Nu-Knit, Ethicon-Johnson & Johnson; GELFOAM, Pfizer). Costing analyses focused on the following outcomes: complications, blood transfusions, surgical revisions, and operating room (OR) time. Cardiac surgery costs were analyzed and expressed in 2012 US dollars based on available literature searches and US data. Comparator group variability in cost consequences (i.e., cost savings) was calculated based on annualized impact and scenario testing.
  
  
  RESULTS
  RESULTS suggest that if a flowable hemostatic matrix (rather than a non-flowable hemostat) was utilized exclusively in 600 mixed cardiac surgeries annually, a hospital could improve patient outcomes by a reduction of 33 major complications, 76 minor complications, 54 surgical revisions, 194 transfusions, and 242 h of OR time. These outcomes correspond to a net annualized cost consequence savings of $5.38 million, with complication avoidance as the largest contributor.
  
  
  CONCLUSIONS
  This cost consequence framework and supportive modeling was used to evaluate the hospital economic impact of outcomes resulting from the usage of various hemostatic agents. These analyses support that cost savings can be achieved from routine use of a flowable hemostatic matrix, rather than a non-flowable topical hemostat, in cardiac surgery.
authors.affiliation: Baxter Healthcare Corporation , Westlake Village, CA , USA.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Tackett
authors.forename: Rebecca
authors.initials: R
authors.lastname: Sugarman
authors.forename: Huub T C
authors.initials: HT
authors.lastname: Kreuwel
authors.forename: Piedad
authors.initials: P
authors.lastname: Alvarez
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nasso
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D004469:Economics, Hospital; D006490:Hemostatics / Q000145:classification / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D018803:Models, Economic; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics
keywords: Cardiac surgery; Complications; Hemostatic matrix; Hospital economic impact; Transfusions