Economic Aspects and Organization
Both bleeding and allogeneic blood transfusion independently increase morbidity, mortality, length of stay in ICU and in hospital, as well as hospital costs. Furthermore, ischemic and thromboembolic events are associated with increased in-hospital and pos
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Klaus Görlinger and Sibylle A. Kozek-Langenecker
24.1
Introduction: The Costs of Blood
Hospitals have limited financial resources, and transfusion and hemostasis management must compete with other diagnostic and therapeutic options for the allocation of funds. At the same time, the costs of blood transfusion continue to increase dramatically and vary widely between countries and even between hospitals within the same country (Table 24.1) (Abraham and Sun 2012; Toner et al. 2011; Glenngård et al. 2005; Varney and Guest 2003). The total cost of supplying patients with hemostatic diagnostics and therapies involves a complex bundle of activity-based costs surrounding the primary supply process, as well as secondary costs linked to transfusion-associated adverse events (Abraham and Sun 2012; Shander et al. 2010). These adverse events account for almost 35 % of transfusionrelated costs (Glenngård et al. 2005). Severe bleeding and inappropriate allogeneic blood transfusion, in particular, are likely to be associated with increased morbidity, length of hospital stay, and additional secondary hospital costs (Berenson et al. 2010; Bufe et al. 2009; Christensen et al. 2009; Leahy and Mukhtar 2012; Pybus et al. 2012; Rao et al. 2008; Sarode et al. 2010; Shander et al. 2011; Stanworth et al. 2011a; Stokes et al. 2011). This chapter discusses the primary and secondary cost implications of hemostatic interventions and transfusion strategies.
K. Görlinger (*) Department of Anaesthesiology and Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, Duisburg-Essen, Germany e-mail: [email protected], [email protected] S.A. Kozek-Langenecker Department of Anaesthesia and Intensive Care, Evangelical Hospital Vienna, Vienna, Austria C.E. Marcucci, P. Schoettker (eds.), Perioperative Hemostasis, DOI 10.1007/978-3-642-55004-1_24, © Springer-Verlag Berlin Heidelberg 2015
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24.2
K. Görlinger and S.A. Kozek-Langenecker
Costs of Bleeding Complications and Allogeneic Blood Transfusion
In addition to increased hospital costs, bleeding and allogeneic blood transfusion have been shown to be independently associated with increased morbidity and mortality and longer stays in intensive care units (ICU) and in hospital (Glance et al. 2011; Khan et al. 2007; Marik and Corwin 2008; Murphy et al. 2007; Pereboom et al. 2009; Sarani et al. 2008; Shander et al. 2007; Spiess et al. 2004; Watson et al. 2009). Blood transfusion costs can be separated into primary or acquisition costs for allogeneic blood products (paid by the government or the hospital itself), activitybased costs (including all processing costs, from the indication of blood transfusion to monitoring effects and for possible adverse events), and secondary costs due to any transfusion-associated adverse events (Shander 2007). Acquisition costs for allogeneic blood products vary widely between countries and are difficult to determine in those where hospitals do not pay for them directly because governments supply them “for fr
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