title: Cost-consequence analysis of different active flowable hemostatic matrices in cardiac surgical procedures.
abstract: BACKGROUND
  A recent retrospective comparative effectiveness study found that use of the FLOSEAL Hemostatic Matrix in cardiac surgery was associated with significantly lower risks of complications, blood transfusions, surgical revisions, and shorter length of surgery than use of SURGIFLO Hemostatic Matrix. These outcome improvements in cardiac surgery procedures may translate to economic savings for hospitals and payers.
  
  
  OBJECTIVE
  The objective of this study was to estimate the cost-consequence of two flowable hemostatic matrices (FLOSEAL or SURGIFLO) in cardiac surgeries for US hospitals.
  
  
  METHODS
  A cost-consequence model was constructed using clinical outcomes from a previously published retrospective comparative effectiveness study of FLOSEAL vs SURGIFLO in adult cardiac surgeries. The model accounted for the reported differences between these products in length of surgery, rates of major and minor complications, surgical revisions, and blood product transfusions. Costs were derived from Healthcare Cost and Utilization Project's National Inpatient Sample (NIS) 2012 database and converted to 2015 US dollars. Savings were modeled for a hospital performing 245 cardiac surgeries annually, as identified as the average for hospitals in the NIS dataset. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to test model robustness.
  
  
  RESULTS
  The results suggest that if FLOSEAL is utilized in a hospital that performs 245 mixed cardiac surgery procedures annually, 11 major complications, 31 minor complications, nine surgical revisions, 79 blood product transfusions, and 260.3 h of cumulative operating time could be avoided. These improved outcomes correspond to a net annualized saving of $1,532,896. Cost savings remained consistent between $1.3m and $1.8m and between $911k and $2.4m, even after accounting for the uncertainty around clinical and cost inputs, in a one-way and probabilistic sensitivity analysis, respectively.
  
  
  CONCLUSIONS
  Outcome differences associated with FLOSEAL vs SURGIFLO that were previously reported in a comparative effectiveness study may result in substantial cost savings for US hospitals.
authors.affiliation: a Baxter Healthcare Corporation , Deerfield , IL , USA.
authors.forename: D
authors.initials: D
authors.lastname: Makhija
authors.affiliation: a Baxter Healthcare Corporation , Deerfield , IL , USA.
authors.forename: M
authors.initials: M
authors.lastname: Rock
authors.affiliation: b Stratevi , Santa Monica , CA , USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Xiong
authors.affiliation: b Stratevi , Santa Monica , CA , USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Epstein
authors.affiliation: a Baxter Healthcare Corporation , Deerfield , IL , USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Arnold
authors.affiliation: c Division of Cardiothoracic Surgery, Department of Surgery , School of Medicine, Emory University , Atlanta , GA , USA.
authors.forename: O M
authors.initials: OM
authors.lastname: Lattouf
authors.affiliation: d Division of Cardiothoracic Surgery , Hennepin Medical Center, Minneapolis Heart Institute at Abbott Northwestern Hospital , Minneapolis , MN , USA.
authors.forename: D
authors.initials: D
authors.lastname: Calcaterra
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D005781:Gelatin Sponge, Absorbable / Q000191:economics; D006490:Hemostatics / Q000191:economics*; D006801:Humans; D017059:Models, Econometric; D009873:Operating Rooms / Q000191:economics; D061646:Operative Time; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D012086:Reoperation / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: C411004:FloSeal Matrix; D006490:Hemostatics
keywords: FLOSEAL; SURGIFLO; cardiac surgery; complications; cost; flowable hemostatic matrix; transfusions