Introduction: Anemia and transfusion of blood products are risk factors associated with poor patient outcomes across all elective surgeries. Patient blood management (PBM) is a patient-centered approach to optimize patient's endogenous red cell mass, to minimize blood loss in patients undergoing surgery, and to harness and optimize patient-specific physiological tolerance to anemia. This study aimed to assess (1) the impact of PBM on blood product usage in cardiovascular surgeries in a state hospital setting, (2) cost-effectiveness of PBM with a model based on transfusion of red blood cells (RBCs) in cardiovascular surgeries, and (3) the budget impact of PBM implementation based on transfusion of RBCs.
Methods: Cost-effectiveness and budget impact models, based on the numbers of avoided transfusions and avoided complications after implementation of the PBM program, were compared between pre- and post-PBM periods at the cardiovascular surgery department of Ankara Bilkent City Hospital between February 11, 2019 and July 24, 2022. The probabilities of transfusions and complications with and without PBM were taken from recent meta-analyses. Data from the Ankara Bilkent City Hospital transfusion center informed the pre- and post-PBM calculations. Costs were calculated from the Social Security Institution's perspective.
Results: There was a 21% decrease in the use of RBCs and a 23.7% decrease in use of all blood products after the implementation of PBM. The number of RBC packs per patient reduced by 0.88 packs (21%). The cost saving from reduction of RBC transfusions per patient was 518.68 Turkish lira (TRY) and for the hospital it was 1,635,948 TRY. Fewer complications and lower costs in favor of the post-PBM arm were demonstrated in the cost-effectiveness analysis. On the basis of the budget impact model, in 20 months, the hospital's cardiovascular surgery department saved 6,596,934 TRY (€342,302).
Conclusion: This hospital-based study demonstrated that PBM is a budget-saving and cost-effective option in Turkey.
Keywords: Budget impact; Cost-effectiveness; Patient blood management; Turkey.
When undergoing elective surgery, patients who develop anemia or who need a transfusion of blood products may develop further complications. This study aimed to understand the impact of patient blood management on blood usage in cardiovascular surgeries. Patient blood management is a patient-centered approach that aims to optimize a patient’s red cell mass, minimize blood loss in patients undergoing surgery, and maximize a patient’s tolerance to anemia. In addition, this study assessed the cost-effectiveness of patient blood management using an economic model based on red blood cells in cardiovascular surgeries and assessed the impact of patient blood management on budget. The patient blood management program resulted in a 21% decrease in use of red blood cells and 23.7% decrease in use of all blood products. The cost savings from reduction of red blood cells transfusions per patient were 518.68 Turkish lira and cost savings for the hospital were 1,635,948 Turkish lira. Fewer complications and lower costs were demonstrated after implementation of patient blood management in the cost-effectiveness analysis. Between December 2020 and July 2022, the hospital’s cardiovascular surgery department saved 6,596,934 Turkish lira (€342,302). Overall, this hospital-based study has shown that patient blood management is a budget-saving and cost-effective option in Turkey.
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