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Association between bleeding, blood transfusion, and costs among patients with non-ST-segment elevation acute
Sunil V Rao1, Padma R Kaul, Lawrence Liao
1The Duke Clinical Research Institute, Durham, NC 27705, USA. sunil.rao@duke.edu
Insights
Bleeding and blood transfusions significantly increase healthcare costs for patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). Reducing bleeding events can lower resource use and associated care expenses.
Area of Science:
- Cardiology
- Health Economics
Background:
- Bleeding and blood transfusions are linked to higher morbidity and mortality in non-ST-segment elevation acute coronary syndromes (NSTE ACS).
- The economic impact of bleeding and transfusions in NSTE ACS patients is not well understood.
Purpose of the Study:
- To investigate the relationship between bleeding, blood transfusion, and associated costs in NSTE ACS patients.
- To quantify the economic consequences of bleeding severity and transfusion requirements.
Main Methods:
- Analysis of data from the GUSTO IIb trial economic substudy (n=1235).
- Utilized linear regression models to assess the cost implications of bleeding and transfusion events.
- Examined relationships between bleeding severity, transfusion, hospital and physician costs, total costs, and length of stay.
Main Results:
- 36.8% of patients experienced a bleeding event.
- Increased bleeding severity correlated with longer hospital stays and higher total costs.
- Moderate/severe bleeding increased costs by $3770 per event; transfusions increased costs by $2080 per event.
- Increased length of stay was the primary driver of higher costs.
Conclusions:
- Bleeding and transfusions are associated with increased resource utilization in NSTE ACS.
- Strategies aimed at reducing both cardiac ischemia and bleeding risk may significantly decrease healthcare costs for NSTE ACS patients.
Background:
Bleeding and blood transfusion are associated with increased morbidity and mortality among patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS); however, the economic consequences of these complications are not well defined. We sought to determine the relationship between bleeding, blood transfusion, and measures of costs among patients with non-ST-segment elevation ACS.
Methods:
We analyzed data from the economic substudy of the GUSTO IIb trial (n = 1235) to determine the relationship between bleeding; transfusion; and hospital costs, physician costs, total costs, and length of stay. Linear regression models were developed to determine the cost implications of each bleeding and transfusion event.
Results:
Of the patients in the economic substudy of GUSTO IIb, 36.8% (n = 455) experienced a bleeding event. As bleeding severity increased, there was a stepwise increase in length of stay (no bleeding 5.4 days, mild bleeding 6.9 days, moderate bleeding 15.0 days, severe bleeding 16.4 days; P < .01) and unadjusted total costs (no bleeding $14,282, mild $21,674, moderate $45,798, severe $66,564; P < .01). After adjustment for baseline differences among patients, each moderate or severe bleeding event increased costs by $3770 and each transfusion event increased costs by $2080. Further modeling demonstrated that the increase in costs was driven by increases in length of stay.
Conclusions:
Bleeding and transfusion are associated with increased resource use among patients with NSTE ACS. These data suggest that strategies that reduce both ischemia and the risk for bleeding have the potential to produce important reductions in the costs of care for patients with NSTE ACS.
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