[Plasma substitutes: strategies for use in intensive therapy to maintain a correct ratio between therapeutic efficacy...

The coice of one product rather than another in clinical practice is based on two main criteria: therapeutic efficacy and the cost of the product in question. However, if therapeutic efficacy is equal, the choice of a less expensive product is not necessarily the right option. We compared the costs and therapeutic efficacy of two products used in plasma replacement therapy in order to identify which would be the most advantageous.

A total of 126 patients due to undergo major abdominal surgery were recruited and, having been duly informed, they were divided into two random groups. One group was treated with a solution of hydroxyethylamide 6% with an intermediate molecular weight (MW 200 kDa SD 0.5), and the other was treated with a solution of modified fluid gelatine (MFG) at 4% (MW 30 kDa). The solutions were administered to patients at the start of surgery until the morning of the first postoperative day in order to maintain mean arterial pressure (MAP) greater than 60 mmHg and central venous pressure (CVP) between 10 and 14 mmHg. Moreover, the costs of the two products and their additional charges were taken into consideration, taken from the supply lists provided by the pharmacy in the hospital where the study was carried out.

No significant differences were found between the two groups in terms of therapeutic efficacy. In economic terms, the cost of the entire infusion treatment was comparable between the two groups in spite of the higher cost of hydroxyethylamide.

The higher cost of hydroxyethylamide was compensated by the fact that a smaller amount of the solution is required to obtain the same hemodynamic parameters guaranteed by gelatine. Moreover, no adverse reactions were reported in this study to either compound. In the international literature, gelatine is associated with adverse reactions in a greater number of cases than hydroxyethylamide. This study shows that when proposing strategies of use, a simple cost analysis of the products used is not sufficient for a correct decision.