Shander A, Ozawa S, Hofmann A
Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, NJ, USA.
Clinical Professor of Anesthesiology, Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Vox Sang. 2016 Jul;111(1):55-61. doi: 10.1111/vox.12386. Epub 2016 Feb 25.
Fresh frozen plasma (FFP) usage has significantly increased over the last decade leading to elevated healthcare costs. Although FFP is used in several clinical settings, it is often inappropriately transfused and evidence for its clinical efficacy is poor. Here, we describe plasma usage and transfusion costs in a real-world US inpatient setting to determine the cost-effectiveness of FFP transfusion and for comparison to various patient blood management (PBM) options to treat coagulopathies.
All activities related to plasma transfusion recorded at a single US hospital over one calendar year were collected in a stepwise manner using an activity-based costing (ABC) methodology. This model maps all technical, administrative and clinical processes inherent to the cost of plasma.
Of 18 200 inpatients recorded, 849 were charged for blood products. In total, 136 medical and surgical inpatients were charged for 577 units of FFP, receiving a total of 534 units; 43 units were charged but not transfused. The total cost per unit of FFP transfused was $409·62 and $1,608·37 per patient transfused with FFP. Wasted products, in-hospital processes and overhead costs were found to account for 89·8% of the total cost of FFP transfusions.
This study is the first to use ABC methodology to determine the full cost of plasma transfusion in a US inpatient setting. These data reveal the true cost of plasma, providing a useful reference point to compare with the cost of other PBM options to manage coagulation disorders.
在过去十年中，新鲜冰冻血浆（FFP）的使用量显著增加，导致医疗成本上升。尽管FFP在多种临床环境中使用，但经常存在不恰当输注的情况，且其临床疗效的证据不足。在此，我们描述美国实际住院患者环境中的血浆使用情况和输血成本，以确定FFP输血的成本效益，并与治疗凝血障碍的各种患者血液管理（PBM）选项进行比较。
使用基于活动的成本核算（ABC）方法，逐步收集美国一家医院在一个日历年内记录的与血浆输血相关的所有活动。该模型描绘了血浆成本所固有的所有技术、行政和临床流程。
在记录的18200名住院患者中，849人被收取血液制品费用。总共，136名内科和外科住院患者被收取577单位FFP的费用，共接受了534单位；43单位已收费但未输注。每单位输注FFP的总成本为409.62美元，每位输注FFP的患者总成本为1608.37美元。发现浪费的产品、医院内流程和间接费用占FFP输血总成本的89.8%。
本研究首次使用ABC方法确定美国住院患者环境中血浆输血的全部成本。这些数据揭示了血浆的真实成本，为与管理凝血障碍的其他PBM选项的成本进行比较提供了有用的参考点。
