Premium
Cryoprecipitate AHF vs. fibrinogen concentrates for fibrinogen replacement in acquired bleeding patients – an economic evaluation
Author(s) -
Okerberg C. K.,
Williams L. A.,
Kilgore M. L.,
Kim C. H.,
Marques M. B.,
Schwartz J.,
Pham H. P.
Publication year - 2016
Publication title -
vox sanguinis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.68
H-Index - 83
eISSN - 1423-0410
pISSN - 0042-9007
DOI - 10.1111/vox.12417
Subject(s) - cryoprecipitate , fibrinogen , medicine , intensive care medicine , surgery
Background Fibrinogen repletion in patients with acquired bleeding disorders can be accomplished by transfusing cryoprecipitate AHF (cryo) or fibrinogen concentrate ( FC ); thus, we undertook an economic evaluation from the transfusion service perspective regarding the use of cryo vs. FC in patients with acquired bleeding. Methods We created a model comparing the cost of cryo vs. FC from the transfusion service perspective. A patient with acquired bleeding requiring fibrinogen replacement could receive either 15–20 cryo units or 3–4 g FC , consistent with the guidelines from the European Task Force for Advanced Bleeding Care in Trauma . All model parameters were estimated from institutional experiences and the medical literature. Additionally, a survey of US Transfusion Medicine fellowship directors was conducted. Results After adjusting for 28% wastage and technologist salary, cryo cost is $414/5‐unit pool. Depending on the dose, FC is more expensive by $976‐$1303. To be competitive with cryo, FC cost must decrease by 44% or be shown to save 0·25–0·66 ICU days. Of the 30 survey replies, 96·7% of US centres do not use FC for acquired bleeding with the top three reasons being cost (30%), off‐label usage (27%) and insufficient evidence for usage (20%). Only 47% are willing to pay more for FC , with $437/g as the median amount. Conclusion Fibrinogen concentrate is more expensive than cryo, even after adjusting for cryo wastage. To be economically competitive with cryo, FC must cost $414/g, or save on ICU length of stay, consistent with the survey's results.