1. 1
I costi trasfusionali
Transfusional costs
Giovanni Inghilleri
Servizio di Immunoematologia e Medicina
Trasfusionale
A.O. Fatebenefratelli e Oftalmico
Milan – Italy
2. 2
Shortcomings of the current health care systems
Dr. Orszag is the director of the Congressional
Budget Office (CBO), a nonpartisan agency that
provides budgetary and economic analyses to
Congress.
3. 3
“Blood has become a scarse and costly resource”
• Doctors are required to deal with the costs of clinical strategies
utilized;
• Blood banks have to optimize the blood components
production;
• Health providers have to decide how to allocate the limited
funds in health care system
• Cost-effectiveness and cost-benefit data should be the base for
any decision making (particularly when “alternatives” have to
be compared) .
Costs of blood transfusion
In a period characterized by worldwide economic crisis
knowledge on costs of blood components and blood
transfusion process is of paramount importance:
4. 5
“Problems” in cost evaluations of blood:
• Cost analysis;
• Economic
evaluations:
– Cost-benefit study
– Cost-effectiveness
study
– Cost-Utility study
Costs of blood transfusion
Different type of analysis can be performed :
Transfusion , 2014 Aug; 54(8): 2034-44
5. 6
“Problems” in cost evaluations of blood:
• Patient;
• Blood Bank
• Department/Hospital
• National Healths
System
• Society
Costs of blood transfusion
Economic studies can be performed taking into account
different “perspective”:
6. 7
Topic of this presentation:
• Cost of Blood Components
• Cost of Transfusion of Blood component
(RBcs);
Costs of blood transfusion
To focus attention on cost-analysis studies on:
Taking primarily into considerations the
perspective of the departments and
hospitals
7. 8
The cost of blood and blood component
Costs of blood transfusion
‘Safety at all costs’ remains
the societal position on the
importance of a safe blood
supply.
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It is the total cost of blood, accounting for all the process
involved in administering a unit of blood, in addiction to the cost
of blood component:
– transfusion request, informed consent procedure,
collecting blood sample, pretransfusion tests, delivering of
blood component, adminstration of blood transfusion,
monitoring, management of adverse events.
Cost estimates of the blood transfusion process are of
great value but are difficult and require precise
methods and high standardization.
Most of the studies evaluated the cost of RBC
administration
The cost of blood transfusion
Costs of blood transfusion
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The Society for the Advancement of Blood Management (SABM) proposed and
assembled a consensus conference to help define appropriate methodology:
Activity-Based Cost model
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STUDY DESIGN AND METHODS:
• An activity-based costing (ABC) model was constructed;
• Tasks and resource consumption (materials, labor, third-party services,
capital) related to blood administration were identified prospectively at
two US and two European hospitals;
• Data collected in the surgical setting;
• Follow-up of acute transfusion-related reactions was included;
• Treatment of long-term complications and rehabilitation associated with
a transfusion-transmissible disease, litigation, and reimbursement or
indemnification for adverse events were omitted;
• The impact of transfusions on hospital length of stay was also not
evaluated.
Up to Feb 2015,
135 citing articles in
CrossRef
17. 18
• Englewood Hospital Medical
Center (EHMC; Englewood, NJ),
• Rhode Island Hospital (RIH;
Providence, RI),
• Centre Hospitalier Universitaire
Vaudois (CHUV; Lausanne,
Switzerland),
• General Hospital Linz (AKH; Linz,
Austria),
Mean total cost per RBC unit was $760.82 + 293.74
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Conclusions
• Blood is actually a scarse and costly resource;
• The cost of 1 unit of RBC is in the range of 130-180 € in
most of the Countries (higher variability occurs for FFP and
PLTs);
• The cost of the transfusion of 1 unit of RBC is much higher,
at least 2-4 fold the cost of acquisition;
• Appropriate use of blood components is the key for their
cost/effectiveness.
• Alternative strategies to blood transfusion could allow not
only to improve the patients safety but also “to save”
money.
Costs of blood transfusion
21. 22
The cost of blood and blood component
How much is the actual cost of blood transfusion?
22. 23
The cost of blood and blood component
How much is the actual cost of blood transfusion?
