title: Cryoprecipitate AHF vs. fibrinogen concentrates for fibrinogen replacement in acquired bleeding patients - an economic evaluation.
abstract: BACKGROUND
  Fibrinogen repletion in patients with acquired bleeding disorders can be accomplished by transfusing cryoprecipitate AHF (cryo) or fibrinogen concentrate (FC); thus, we undertook an economic evaluation from the transfusion service perspective regarding the use of cryo vs. FC in patients with acquired bleeding.
  
  
  METHODS
  We created a model comparing the cost of cryo vs. FC from the transfusion service perspective. A patient with acquired bleeding requiring fibrinogen replacement could receive either 15-20 cryo units or 3-4 g FC, consistent with the guidelines from the European Task Force for Advanced Bleeding Care in Trauma. All model parameters were estimated from institutional experiences and the medical literature. Additionally, a survey of US Transfusion Medicine fellowship directors was conducted.
  
  
  RESULTS
  After adjusting for 28% wastage and technologist salary, cryo cost is $414/5-unit pool. Depending on the dose, FC is more expensive by $976-$1303. To be competitive with cryo, FC cost must decrease by 44% or be shown to save 0·25-0·66 ICU days. Of the 30 survey replies, 96·7% of US centres do not use FC for acquired bleeding with the top three reasons being cost (30%), off-label usage (27%) and insufficient evidence for usage (20%). Only 47% are willing to pay more for FC, with $437/g as the median amount.
  
  
  CONCLUSIONS
  Fibrinogen concentrate is more expensive than cryo, even after adjusting for cryo wastage. To be economically competitive with cryo, FC must cost $414/g, or save on ICU length of stay, consistent with the survey's results.
authors.affiliation: Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: C K
authors.initials: CK
authors.lastname: Okerberg
authors.affiliation: Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Williams
authors.affiliation: Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Kilgore
authors.affiliation: Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: C H
authors.initials: CH
authors.lastname: Kim
authors.affiliation: Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Marques
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center and the New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: J
authors.initials: J
authors.lastname: Schwartz
authors.affiliation: Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA. huyppham@uab.edu.
authors.forename: H P
authors.initials: HP
authors.lastname: Pham
mesh_terms: D001803:Blood Transfusion; D003362:Cost-Benefit Analysis; D005169:Factor VIII / Q000191:economics / Q000627:therapeutic use*; D005340:Fibrinogen / Q000191:economics / Q000627:therapeutic use*; D006470:Hemorrhage / Q000188:drug therapy*; D006801:Humans; D018803:Models, Economic; D011795:Surveys and Questionnaires
chemical_list: C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen
keywords: RiaSTAP®; blood product; cost-effectiveness; cryoprecipitate; fibrinogen concentrate; haemorrhage; plasma derivative; transfusion