TRUE COST OF TRANSFUSION AND MEASURES TO TAME IT pp. 101-119
Authors: (Aryeh Shander, Mount Sinai School of Medicine and Axel Hoffman, Engelwood Hospital and Medical Center, USA)
Abstract: Providing health care at reduced cost, while maintaining and possibly improving its effect and quality remains the holy grail of health economics. The case of blood transfusion is an interesting example of a health care modality which is widely oversubscribed to, overused and plagued with myths and misconceptions, in spite of availability of numerous opportunities for improving the quality of care while lowering the costs. Unjustified transfusions impose an enormous financial burden on health care system, which is often gone unnoticed. The nominal cost of a unit of blood is just the tip of the iceberg of the multitudes of resources employed in procuring and screening donors and acquisition, testing, processing, storing, distributing and administrating blood. The costs incurred following transfusions are occasionally even higher, considering the unfavorable outcomes frequently associated with transfusions (e.g. increased morbidity and longer stays at hospital) as well as a long list of less frequent yet more serious adverse reactions and complications, which can cost millions of dollars in processes ranging from medical management to litigation. Systematic efforts at identifying the elements involved in blood transfusion are described and an equation to estimate the cost of blood transfusion based on these elements is presented alongside with an overview of costs to manage transfusion-related adverse events. Cost-effectiveness of various options and procedures performed on blood (e.g. white blood cell reduction and pathogen inactivation) is reviewed. Finally, blood conservation strategies as options to reduce or eliminate transfusion and the economic opportunities provided by these modalities are scrutinized. Cumulative evidence points out that an evidence-based restrictive transfusion practice coupled with blood conservation strategies can result in higher quality of care while reducing health care costs. Blood transfusions are becoming increasingly costly and hard to supply and they should be reserved for situations where they are clearly indicated. Avoiding their unjustified use will positively serve both the patients and the health care system.