Activity-based costs of blood transfusions in surgical patients at four hospitals
Aryeh Shander
From The Institute for Patient Blood Management and Bloodless Medicine at Englewood Hospital and Medical Center, Englewood, New Jersey; the Medical Society for Blood Management, Laxenburg, Austria; the Department of Anesthesiology, University Hospital Lausanne, Lausanne, Switzerland; the Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland; and the Department of Anesthesiology and Intensive Care, General Hospital, Linz, Austria.
Search for more papers by this authorAxel Hofmann
From The Institute for Patient Blood Management and Bloodless Medicine at Englewood Hospital and Medical Center, Englewood, New Jersey; the Medical Society for Blood Management, Laxenburg, Austria; the Department of Anesthesiology, University Hospital Lausanne, Lausanne, Switzerland; the Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland; and the Department of Anesthesiology and Intensive Care, General Hospital, Linz, Austria.
Search for more papers by this authorSherri Ozawa
From The Institute for Patient Blood Management and Bloodless Medicine at Englewood Hospital and Medical Center, Englewood, New Jersey; the Medical Society for Blood Management, Laxenburg, Austria; the Department of Anesthesiology, University Hospital Lausanne, Lausanne, Switzerland; the Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland; and the Department of Anesthesiology and Intensive Care, General Hospital, Linz, Austria.
Search for more papers by this authorOliver M. Theusinger
From The Institute for Patient Blood Management and Bloodless Medicine at Englewood Hospital and Medical Center, Englewood, New Jersey; the Medical Society for Blood Management, Laxenburg, Austria; the Department of Anesthesiology, University Hospital Lausanne, Lausanne, Switzerland; the Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland; and the Department of Anesthesiology and Intensive Care, General Hospital, Linz, Austria.
Search for more papers by this authorHans Gombotz
From The Institute for Patient Blood Management and Bloodless Medicine at Englewood Hospital and Medical Center, Englewood, New Jersey; the Medical Society for Blood Management, Laxenburg, Austria; the Department of Anesthesiology, University Hospital Lausanne, Lausanne, Switzerland; the Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland; and the Department of Anesthesiology and Intensive Care, General Hospital, Linz, Austria.
Search for more papers by this authorDonat R. Spahn
From The Institute for Patient Blood Management and Bloodless Medicine at Englewood Hospital and Medical Center, Englewood, New Jersey; the Medical Society for Blood Management, Laxenburg, Austria; the Department of Anesthesiology, University Hospital Lausanne, Lausanne, Switzerland; the Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland; and the Department of Anesthesiology and Intensive Care, General Hospital, Linz, Austria.
Search for more papers by this authorAryeh Shander
From The Institute for Patient Blood Management and Bloodless Medicine at Englewood Hospital and Medical Center, Englewood, New Jersey; the Medical Society for Blood Management, Laxenburg, Austria; the Department of Anesthesiology, University Hospital Lausanne, Lausanne, Switzerland; the Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland; and the Department of Anesthesiology and Intensive Care, General Hospital, Linz, Austria.
Search for more papers by this authorAxel Hofmann
From The Institute for Patient Blood Management and Bloodless Medicine at Englewood Hospital and Medical Center, Englewood, New Jersey; the Medical Society for Blood Management, Laxenburg, Austria; the Department of Anesthesiology, University Hospital Lausanne, Lausanne, Switzerland; the Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland; and the Department of Anesthesiology and Intensive Care, General Hospital, Linz, Austria.
Search for more papers by this authorSherri Ozawa
From The Institute for Patient Blood Management and Bloodless Medicine at Englewood Hospital and Medical Center, Englewood, New Jersey; the Medical Society for Blood Management, Laxenburg, Austria; the Department of Anesthesiology, University Hospital Lausanne, Lausanne, Switzerland; the Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland; and the Department of Anesthesiology and Intensive Care, General Hospital, Linz, Austria.
Search for more papers by this authorOliver M. Theusinger
From The Institute for Patient Blood Management and Bloodless Medicine at Englewood Hospital and Medical Center, Englewood, New Jersey; the Medical Society for Blood Management, Laxenburg, Austria; the Department of Anesthesiology, University Hospital Lausanne, Lausanne, Switzerland; the Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland; and the Department of Anesthesiology and Intensive Care, General Hospital, Linz, Austria.
Search for more papers by this authorHans Gombotz
From The Institute for Patient Blood Management and Bloodless Medicine at Englewood Hospital and Medical Center, Englewood, New Jersey; the Medical Society for Blood Management, Laxenburg, Austria; the Department of Anesthesiology, University Hospital Lausanne, Lausanne, Switzerland; the Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland; and the Department of Anesthesiology and Intensive Care, General Hospital, Linz, Austria.
Search for more papers by this authorDonat R. Spahn
From The Institute for Patient Blood Management and Bloodless Medicine at Englewood Hospital and Medical Center, Englewood, New Jersey; the Medical Society for Blood Management, Laxenburg, Austria; the Department of Anesthesiology, University Hospital Lausanne, Lausanne, Switzerland; the Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland; and the Department of Anesthesiology and Intensive Care, General Hospital, Linz, Austria.
Search for more papers by this authorA preliminary, partial report of this work was presented at the American Society of Hematology Meeting, San Francisco, CA, December 2008: Shander A, Hofmann A, Ozawa S, Javidroozi M. The true cost of red blood cell transfusion in surgical patients. Blood 2008;112: Abstract 3045.
Funding to support this research, including ABC software development and manuscript preparation, was provided by the Society for the Advancement of Blood Management (SABM), made possible by a grant from Centocor Ortho Biotech Services, LLC. Janssen-Cilag AG and Janssen-Cilag GmbH also contributed funding for research conducted in Europe.
Abstract
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.
Supporting Information
APPENDIX S1. Alphabetical list of COBCON participants
APPENDIX S2. Activity-based costing: process flow diagram (LEVEL 1: Surgical patients—allogeneic blood transfusion)
APPENDIX S3. Activity-based costing: process flow diagram (LEVEL 2: Surgical patients—administering & monitoring transfusion on ward)
TABLE S1. Hospital blood bank supply management for RBCs
TABLE S2. Pre-transfusion processes
TABLE S3. Patient blood testing processes
TABLE S4. Specific transfusion consent form
TABLE S5. Issuing and delivering components from blood bank to transfusion sites
TABLE S6. Administering and monitoring transfusions
TABLE S7. Managing acute transfusion reactions and hemovigilance
TABLE S8. Post-transfusion logistics
| Filename | Description |
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| TRF_2518_sm_SuppInfor.doc162 KB | Supporting info item |
| TRF_2518_sm_APPENDIX_S2.pdf101.9 KB | Supporting info item |
| TRF_2518_sm_APPENDIX_S3.pdf138.5 KB | Supporting info item |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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