Singbartl G, Schleinzer W
ENDO-Klinik Hamburg.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1999 Jun;34(6):350-8. doi: 10.1055/s-1999-8741.
Cost analysis of autologous blood conservation measures compared to corresponding homologous blood products.
This study is based on data from 5,017 patients undergoing major bone and joint surgery in 1993 and participating preoperatively in autologous blood donation (ABD) (with hemoseparation (HS) into autologous packed red blood cells (APRBC) and autologous fresh-frozen-plasma (AFFP)), autologous plasmapheresis (APPH) for harvesting AFFP as well as intra-/postoperative blood salvage with mechanically processed autologous transfusion (MAT).
Total costs for 3,110 ABD with HS amount to DM 517,586.00 resulting in about DM 167.00 per U of APRBC plus AFFP. Comparatively, costs per U of HPRBC is about DM 202.00. Break-even-point (BEP) is calculated with 2,258 U of APRBC (without considering AFFP additionally obtained by HS). Taking into account this AFFP due to coagulation in 20% lowers BEP to 1,819 U of APRBC. However, this analysis compares the "mere" cost figures only, but does not consider the extent of ABD-induced increase in rbc mass compared to that of HPRBC. Under these circumstances calculated cost per unit of APRBC is up to 90 per cent higher than for 1 U of HPRBC. Total cost for PPH with 15,570 U of AFFP amounts to about DM 1,824,162.00, resulting in about DM 115.00 per U of AFFP. Comparatively, cost per U of HFFP is about DM 136.00. BEP is calculated with 11,595 U of AFFP. However, when considering AFFP on coagulatory reasons' with 20% only, no BEP can be calculated and AFFP is not proven to be cost-efficient. Under these conditions it is about 2.8-times more expensive than HFFP; and if considering AFFP a volume substitute it is even more than twelve times more expensive than artificial colloids (e.g. HES 6%, 200/0.5). MAT--2,690 sets and patients with a total of 5,326 processing cycles--causes a total cost of about DM 1,356,161.00, resulting in about DM 504.00 per set and patient. Under our conditions MAT is not cost-efficient compared to HPRBC as it is about two times more expensive than HPRBC. For reaching cost efficiency the number of processing cycles is either to be increased from about 2 to about 4 cycles per set and patient or hematocrit of the rbc-product obtained by MAT is clearly to be increased.
The "mere" figures of this cost analysis of APRBC versus HPRBC as well as of AFFP versus HFFP and HES appear in favour of the autologous products. However, such an analysis should consider--besides the costs--both the increase in rbc-mass obtained by ABD or MAT, versus homologous rbc, and the indication for administering AFFP. This study does not prove our autologous blood conservation measures to be cost efficient compared to homologous blood products. Therefore, these data may cause a critically reflection on established concepts of autologous transfusion measures and may initiate promoting new and more cost efficient constellations/alternatives of blood conservation measures.
将自体血液保存措施与相应的同种异体血液制品进行成本分析。
本研究基于1993年5017例接受大骨和关节手术患者的数据，这些患者术前参与了自体血液捐献（ABD）（通过血液分离（HS）获得自体浓缩红细胞（APRBC）和自体新鲜冰冻血浆（AFFP））、用于采集AFFP的自体血浆置换（APPH）以及术中/术后机械处理的自体输血（MAT）。
3110例采用HS的ABD总成本为517,586.00德国马克，每单位APRBC加AFFP约为167.00德国马克。相比之下，每单位HPRBC成本约为202.00德国马克。盈亏平衡点（BEP）计算为2258单位APRBC（未额外考虑通过HS获得的AFFP）。由于20%的凝血作用考虑到该AFFP后，BEP降至1819单位APRBC。然而，该分析仅比较了“单纯”的成本数字，未考虑与HPRBC相比ABD引起的红细胞量增加程度。在这种情况下，计算得出的每单位APRBC成本比1单位HPRBC高出90%。15570单位AFFP的PPH总成本约为1,824,162.00德国马克，每单位AFFP约为115.00德国马克。相比之下，每单位HFFP成本约为136.00德国马克。BEP计算为11595单位AFFP。然而，仅考虑20%因凝血作用的AFFP时，无法计算BEP，且AFFP未被证明具有成本效益。在这些条件下，它比HFFP贵约2.8倍；如果将AFFP视为容量替代品，它甚至比人工胶体（如6%羟乙基淀粉，200/0.5）贵十二倍以上。MAT（2690套及患者，共5326个处理周期）总成本约为1,356,161.00德国马克，每套及患者约为504.00德国马克。在我们的条件下，与HPRBC相比，MAT不具有成本效益，因为它比HPRBC贵约两倍。为实现成本效益，每套及患者的处理周期数要么从约2个增加到约4个，要么MAT获得的红细胞产品的血细胞比容要显著提高。
APRBC与HPRBC以及AFFP与HFFP和羟乙基淀粉的这种成本分析的“单纯”数字似乎有利于自体产品。然而，除成本外，这种分析还应考虑通过ABD或MAT获得的红细胞量增加与同种异体红细胞相比情况，以及使用AFFP的指征。与同种异体血液制品相比，本研究未证明我们的自体血液保存措施具有成本效益。因此，这些数据可能会引发对既定自体输血措施概念的批判性反思，并可能促使推动新的、更具成本效益的血液保存措施组合/替代方案。
