Cryoprecipitate AHF vs. fibrinogen concentrates for fibrinogen replacement in acquired bleeding patients - an economic evaluation
Cryoprecipitate AHF vs. fibrinogen concentrates for fibrinogen replacement in acquired bleeding patients - an economic evaluation
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DOI：
10.1111/vox.12417
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发表时间：
2016-10-01
期刊：
影响因子：
2.7
通讯作者：
Pham, H. P.
中科院分区：
文献类型：
--
作者：
Okerberg, C. K.;Williams, L. A., III;Pham, H. P.
背景：获得性出血性疾病患者的纤维蛋白原补充可以通过输入低温沉淀AHF （cryo）或纤维蛋白原浓缩物（FC）来实现；因此，我们从输血服务的角度对获得性出血患者使用冷冻与FC进行了经济评估。方法建立一个从输血服务角度比较冷冻与FC成本的模型。需要纤维蛋白原替代的获得性出血患者可以接受15-20个冷冻单位或3-4克FC，这与欧洲创伤高级出血护理工作组的指南一致。所有模型参数都是根据机构经验和医学文献估计的。此外，对美国输血医学协会主任进行了调查。结果经28%的损耗和技术人员工资调整后，冷冻成本为414美元/5个单位池。根据剂量的不同，FC要贵976- 1303美元。为了与冷冻技术竞争，FC成本必须降低44%或节省0.25-0.66 ICU天。在30份调查回复中，96.7%的美国中心不使用氟氯烃治疗获得性出血，前三大原因是成本（30%）、超说明书使用（27%）和使用证据不足（20%）。只有47%的人愿意为FC支付更高的价格，平均价格为437美元/克。结论浓缩纤维蛋白原比冷冻更昂贵，即使经过冷冻损耗调整。为了在经济上与冷冻相比具有竞争力，FC的成本必须为每克414美元，或者节省ICU的住院时间，这与调查结果一致。
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.Conclusion 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.