Premium
Activity‐based costs of blood transfusions in surgical patients at four hospitals
Author(s) -
Shander Aryeh,
Hofmann Axel,
Ozawa Sherri,
Theusinger Oliver M.,
Gombotz Hans,
Spahn Donat R.
Publication year - 2010
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2009.02518.x
Subject(s) - medicine , activity based costing , health care , population , emergency medicine , indirect costs , cost driver , blood product , blood transfusion , medical emergency , acute care , intensive care medicine , operations management , environmental health , surgery , business , accounting , marketing , economics , economic growth
BACKGROUND: Blood utilization has long been suspected to consume more health care resources than previously reported. Incomplete accounting for blood costs has the potential to misdirect programmatic decision making by health care systems. Determining the cost of supplying patients with blood transfusions requires an in‐depth examination of the complex array of activities surrounding the decision to transfuse. STUDY DESIGN AND METHODS: To accurately determine the cost of blood in a surgical population from a health system perspective, an activity‐based costing (ABC) model was constructed. Tasks and resource consumption (materials, labor, third‐party services, capital) related to blood administration were identified prospectively at two US and two European hospitals. Process frequency (i.e., usage) data were captured retrospectively from each hospital and used to populate the ABC model. RESULTS: All major process steps, staff, and consumables to provide red blood cell (RBC) transfusions to surgical patients, including usage frequencies, and direct and indirect overhead costs contributed to per‐RBC‐unit costs between $522 and $1183 (mean, $761 ± $294). These exceed previously reported estimates and were 3.2‐ to 4.8‐fold higher than blood product acquisition costs. Annual expenditures on blood and transfusion‐related activities, limited to surgical patients, ranged from $1.62 to $6.03 million per hospital and were largely related to the transfusion rate. CONCLUSION: Applicable to various hospital practices, the ABC model confirms that blood costs have been underestimated and that they are geographically variable and identifies opportunities for cost containment. Studies to determine whether more stringent control of blood utilization improves health care utilization and quality, and further reduces costs, are warranted.