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Published on: September 9, 2012
Trends in the utilization and wastage of coagulation factor concentrates: the application of a regional tracking
D M Arnold1, K E Webert, J Carruthers
1Department of Medicine, McMaster University, Hamilton, ON, Canada. arnold@mcmaster.ca
Insights
Coagulation factor concentrate utilization, including Factor VIII, IX, and VIIa, increased significantly between 2001-2004. A tracking program demonstrated feasibility for monitoring trends and reducing waste in blood products.
Area of Science:
- Hematology
- Pharmacoeconomics
- Public Health Surveillance
Background:
- The Krever Commission (1997) recommended active surveillance for blood products.
- Effective monitoring of coagulation factor concentrate use is crucial for patient care and resource management.
Purpose of the Study:
- To describe trends in coagulation factor concentrate utilization.
- To evaluate the feasibility of a comprehensive factor tracking program.
Main Methods:
- Prospective tracking of coagulation factor concentrates (FVIII, FIX, FVIIa) in Southern Ontario (2001-2004).
- Monitoring distribution, hospital issuance, infusions (inpatient/home), and wastage.
- Independent audits to reconcile discrepancies.
Main Results:
- Utilization of FVIII, FIX, and FVIIa increased annually by 13.7%, 33.2%, and 34.2%, respectively.
- Increased usage was driven by higher per-patient consumption, primarily for prophylaxis.
- 1.7% of concentrates were wasted, costing over 1 million CAD.
Conclusions:
- Coagulation factor concentrate utilization shows a steady upward trend.
- A regional tracking program is feasible for trend analysis, planning, and cost reduction through minimized wastage.
Abstract:
The Commission of Inquiry on the Blood System in Canada ('Krever Commission', 1997) recommended an active programme of surveillance for all blood products. To describe trends in the utilization of coagulation factor concentrates using a comprehensive factor tracking programme. Between 2001 and 2004 in the region of Southern Ontario, we prospectively tracked all coagulation factor concentrates that were distributed from the national blood supplier, issued by hospitals for inpatient use or for home infusions, infused at hospital facilities or at home and wasted. Discrepancies were reconciled by independent audits. Trends in the utilization of FVIII, FIX and FVIIa concentrates are reported. A total of 466 patients with inherited or acquired bleeding disorders were registered. Utilization of FVIII, FIX and FVIIa increased by an average of 13.7%, 33.2% and 34.2% per year respectively. Most FVIII and FIX infusions were administered at home while most FVIIa infusions were in hospital. The increase in FVIII and FIX usage was attributable to an increase in per-patient use, predominantly for prophylaxis. In total, 1.7% of coagulation factor concentrates was wasted during the study period, at a cost of over 1 million Canadian dollars. Utilization of coagulation factor concentrates increased steadily during the study period. A regional programme to track utilization is feasible and may be used to describe trends, assist planning, and reduce costs by minimizing wastage.
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