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Cost/benefit analysis of pharmacologic hemostasis
1Department of Cardiovascular and Transplant Anesthesia, Alton Ochsner Clinic, New Orleans, Louisiana 70121, USA.
The Annals of Thoracic Surgery
|February 1, 1996
Summary
Pharmacologic hemostasis agents reduce transfusion needs in surgery. Epsilon-aminocaproic acid offers significant cost savings compared to other agents like aprotinin.
Area of Science:
- Anesthesiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Surgical bleeding and coagulopathies contribute to patient morbidity and mortality.
- Over 27% of patients undergoing cardiac surgery receive unnecessary blood transfusions.
- Cost-benefit analysis of pharmacologic hemostasis requires evaluating direct and indirect costs and benefits.
Purpose of the Study:
- To analyze the cost-benefit of pharmacologic hemostasis agents in reducing surgical bleeding and transfusion requirements.
- To compare the efficacy and cost-effectiveness of different hemostatic drugs.
Main Methods:
- Systematic application of a clinical algorithm to reduce transfusion needs.
- Administration of pharmacologic agents to enhance hemostasis.
- Evaluation of four common agents: desmopressin acetate, tranexamic acid, epsilon-aminocaproic acid, and aprotinin.
Main Results:
- Epsilon-aminocaproic acid (EACA) treatment costs less than $2, with blood valued at $30.
- Aprotinin use incurs costs exceeding $500, with the drug alone costing $900.
- All evaluated agents demonstrate efficacy in reducing bleeding and transfusion needs.
Conclusions:
- Pharmacologic hemostasis agents effectively reduce bleeding and transfusion requirements.
- Epsilon-aminocaproic acid presents a favorable cost-benefit profile compared to aprotinin.
- Improved hemostasis leads to indirect cost savings through reduced OR time, ICU/hospital stay, and reoperations.