Transfusion-free surgery is a treatment plan for all patients

Cost-minimization analysis of darbepoetin alfa versus epoetin alfa in the hospital setting

PURPOSE

The cost of darbepoetin alfa versus that of epoetin alfa in a hospital setting was studied.

METHODS

The study was an observational, retrospective review of the hospitalwide use of darbepoetin and epoetin during hospital admissions beginning in the period from January 2003 through April 2003. After the identification from daily charge reports of patients who used at least one of the study drugs during an admission, charts were requested for review. Drug product costs were determined from hospital purchasing information. Material and labor costs were combined to estimate drug administration costs. Total costs were calculated as the sum of drug product costs and administration costs.

RESULTS

A total of 429 epoetin records and 80 darbepoetin records were included. The two cohorts were similar with respect to demographic characteristics. With respect to costs, the only significant difference between cohorts was in daily administration costs, which were lower for patients receiving darbepoetin. Sensitivity analysis found lower costs for darbepoetin only after the dose-conversion ratio (DCR) was increased to above 256.74 units:1 microg. The overall DCR based on the median daily dose of each drug was 244.90 units:1 microg.

CONCLUSION

A cost-minimization study in a hospital showed no cost difference between treatment with epoetin and darbepoetin.

Blood Conservation Strategies in Cardiovascular Surgery

Blood conservation is a measurable intervention in which clinical and financial outcomes may be tracked. This article describes a systems approach to blood conservation for a cardiac surgery population. Four key areas are discussed: needs assessment, committee construction, blood conservation strategies, and outcome measurement. Specific evidenced-based blood conservation strategies include, but are not limited to, transfusion risk index, phlebotomy techniques, management of hemostasis and hemoglobin levels which includes blood testing, pharmacologic agents, and blood transfusion prescription guidelines.

Blood transfusion in the perioperative period

In the perioperative period, blood transfusions are most commonly administered to address acute blood loss resulting from trauma, neoplasia, or surgery. In this setting, transfusions may be life saving, allowing time for clotting or surgical hemostasis. In recent years, however, there is a growing awareness that the administration of blood products may not be a benign treatment. In addition to the more commonly cited complications such as transfusion reactions, disease transmission, and electrolyte disturbances, blood transfusions have also been linked to poor surgical outcomes, increased risk of infection, cancer recurrence, and acute lung injury. The recognition of these problems has lead to more conservative transfusion strategies, and questioning of what constitutes an appropriate transfusion trigger. In this section, we will discuss the pathophysiology of acute blood loss, the benefits and risks of transfusions in surgical patients, management of perioperative blood transfusions, and alternative strategies to minimize the need for blood products.

How can autologous blood transfusions help our patients?

In modern day clinical nursing practice, respecting and encouraging patient autonomy, together with acting as advocate for the patient, is an integral part of holistic patient care. We have a 'duty of care' to our patients. So why, in the early days of the 21st century, are we still transfusing our patients with homologous blood products when there is a safer alternative which has been recognised for almost 200 years?