Zilberberg Marya D, Shorr Andrew F
University of Massachusetts, 715 North Pleasant Street, Amherst, MA 01003, USA.
BMC Health Serv Res. 2007 Aug 31;7:138. doi: 10.1186/1472-6963-7-138.
Nearly half of all patients in the Intensive Care Unit (ICU) receive red blood cell (pRBC) transfusions (TFs), despite their associated complications. Restrictive transfusion strategy (Hemoglobin [Hb] < 7 g/dL) has been shown to reduce TF exposure. We estimated the potential annual reduction in transfusion-attributable severe acute complications (TSACs) and costs across the US ICUs with the adoption of restrictive strategy.
A model, utilizing inputs from published studies, was constructed. Step 1 calculated potential number of patients appropriate for this strategy. In step 2, total number of pRBC units avoided with the restrictive trigger was extrapolated to the annual TFs in the US ICUs. Step 3 quantified excess acute complications and the number of pRBC units TF/1 TSAC in the TRICC trial. Step 4 transformed restrictive strategy-related avoidance of pRBC units to a reduction in TSACs, and step 5 quantified the associated cost savings.
Of the 4.4 million annual ICU admissions, 1,020,800 comprised the at-risk population. The total of 1,295,126 units of pRBC ($643/unit) could be saved with the restrictive strategy. Based on the data from the TRICC trial, dividing the 49 excess complications in the liberal group into the calculated excess of pRBCs transfused (1,624 units) yielded the rate of 33 pRBC units per one complication. Thus, dividing 1,295,126 units saved by 33 units/1 TSAC, the base-case analysis showed that 39,246 TSACs could potentially be avoided annually in the US ICUs, with the cost savings of $821,109,826.
This model demonstrates that a restrictive transfusion strategy in appropriate at risk ICU patients is dominant and could result in improved quality of care and cost savings. Given the potential savings of 40,000 TSACs and nearly $1 billion, it is incumbent upon the intensivist community to promote more ubiquitous adoption of a clinically appropriate restrictive transfusion strategy in the ICU.
尽管存在相关并发症，但重症监护病房（ICU）中近一半的患者接受了红细胞（pRBC）输血（TFs）。限制性输血策略（血红蛋白[Hb]<7 g/dL）已被证明可减少TF暴露。我们估计了在美国ICU中采用限制性策略后每年输血相关严重急性并发症（TSACs）和成本的潜在降低情况。
构建了一个利用已发表研究数据的模型。第一步计算适合该策略的潜在患者数量。第二步，将限制性触发因素避免的pRBC单位总数外推至美国ICU的年度TFs。第三步，量化TRICC试验中额外的急性并发症以及每1例TSAC的pRBC单位TF数量。第四步，将与限制性策略相关的pRBC单位避免量转化为TSACs的减少量，第五步量化相关的成本节约。
在每年440万例ICU入院患者中，1,020,800例为高危人群。采用限制性策略可节省总计1,295,126单位的pRBC（每单位643美元）。根据TRICC试验的数据，将宽松组中49例额外并发症除以计算出的额外输注的pRBC（1,624单位），得出每例并发症33个pRBC单位的发生率。因此，将节省的1,295,126单位除以33单位/1例TSAC，基线分析表明，美国ICU每年可能避免39,246例TSACs，成本节约821,109,826美元。
该模型表明，对合适的高危ICU患者采用限制性输血策略具有优势，可提高医疗质量并节省成本。鉴于可能节省40,000例TSACs和近10亿美元，重症监护医生群体有责任促进在ICU中更广泛地采用临床适当的限制性输血策略。
