Management of perioperative iron deficiency anemia as part of patient blood management in France: A budget impact model-based analysis based on real world data

OBJECTIVES

Patient Blood Management (PBM) is defined as a patient-centered, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood, while promoting patient safety and empowerment. As a corollary, it also reduces the utilization of allogeneic blood components. However, demonstrating cost-effectiveness depends on the health insurance system considered. This analysis aims to estimate the one-year budget impact of PBM in four elective surgical areas, from French National Health Insurance and hospital perspectives.

METHODS

A budget impact model was developed to estimate the difference in the cost of care between scenarios with and without PBM. The impact of hematopoiesis optimization (first pillar of PBM) was studied throughout the management of preoperative anemia and iron deficiency in four types of surgeries: orthopedic, cardiac & cardiovascular, vascular & thoracic, and urologic & visceral surgery. Estimation of model's parameters was based on data collected in 10 French hospitals, literature, and on data from the French national medico-administrative database.

RESULTS

A total of 980,125 patients were modeled for all four therapeutic areas. Results shows that implementation of a PBM program could generate annual savings up to €1079 M from the French National Health Insurance perspective (€1018 M from the hospital perspective), and the sparing of 181,451 red blood cells units per year. The deterministic sensitivity analysis showed that PBM generates savings for both perspectives in most parameters tested.

CONCLUSION

Implementing PBM programs could result in important savings for the health care system in France.

[Assessment of efficacy of hypertonic saline - hydroxyethylstarch in haemorrhagic shock]

OBJECTIVE

Assessment of haemodynamic, respiratory and renal effects of hypertonic saline-hydroxyethyl starch (HyperHES) in critically ill-patients with hemorrhagic shock.

PATIENTS AND METHODS

Seventeen mechanically ventilated patients with hemorragic shock benefiting from a cardiovascular monitoring by PiCCO device and requiring rapid volume loading. Two hundred and fifty milliliters of HyperHES were given over 5 minutes. The efficacy of volume loading was assessed by the measure of the systolic arterial pressure (SAP), cardiac index (CI), stroke volume variation (SVV) and the indexed systemic vascular resistance (iSVR). Studied parameters were assessed at baseline, 5, 30, 60 and 180 minutes after the end of HyperHES infusion.

RESULTS

SAP (105 + or - 23 vs 77 + or - 10; p<0.001) and CI (4.8 + or - 1.1 vs 3.5 + or - 0.9; p<0.001) were significantly increased whereas iSVR (1175 + or - 310 vs 1501 + or - 337; p<0.01) and SVV (13 + or - 7 vs 20 + or - 5; p<0.01) were significantly decreased 5 minutes after the HyperHES infusion. Sodium (145 + or - 6 vs 136 + or - 5; p<0.001) and chloride (118 + or - 7 vs 107 + or - 6; p<0.001) were increased 5 minutes after the infusion. The PaO(2)/FiO(2) ratio as the extravascular lung water was not influenced by the infusion. The follow-up of renal parameters during the three first days (creatinemia, uremia and diuresis) did not revelead significant variations.

CONCLUSION

In patients with hemorrhagic shock, the infusion of hypertonic saline (7.5%) hydroxyethyl starch association was followed by an increase in SAP, CI serum sodium and chloride concentrations.

STUDY DESIGN

Prospective observational study.

Quantification of the Normandy and Picardy chalk cliff retreat by photogrammetric analysis

The chalk cliffs of Normandy and Picardy are retreating rapidly and approaching the built-up areas located near the shore. Previous studies of cliff retreat in this area suffer from a large margin of error (absolute error in cliff position is ±7 m) due to the techniques and methods used. This paper presents a recent study which aims to quantify the chalk cliff retreat between 1966 and 1995 by means of photogrammetric analysis. In addition to the very high accuracy of the results (absolute error in cliff position is ±0.3 m), this technique gives geo-referenced numeric data allowing the creation of a geographical databank intended to become a tool for hazard management in coastal zones. Three scales of analysis have been used: a retreat value per hydro-sedimentary cell, per sub-cell and one every 50m. These scales show that this regressive dynamic is spatially very variable. However, three zones of distinct retreat rates are apparent. These appear to be linked with the lithological characteristics of the chalk. Furthermore, the quantification associated with the flint content of the cliff allows an assessment of the flint shingle provision from the cliff to the shore.