Budget Impact of Preoperative Anemia Management, the First Pillar of Patient Blood Management, on the Romanian Healthcare System

OBJECTIVES: This study aimed to quantify the potential health economic benefits of implementing preoperative anemia management in the Romanian hospitals.

METHODS: A decision-tree health economic model from a published study from Turkey was adapted and populated with local cost and epidemiologic data from Romania to assess the budget impact of implementing treatment with Ferric carboxymaltose (FCM) as a measure for anemia management, the first pillar of patient blood management (PBM). Where local data was not available, the model was populated with published data. Cardiac (coronary artery bypass grafting) and non-cardiac (hip and knee arthroplasty) elective surgery cases were analyzed as subgroups. Cost of complications per discharged case was assessed using the standard cost measurement methodology of the controlling system from 10 Romanian hospitals. In the model FCM was used as iron deficiency anemia treatment.

RESULTS: In 2019, at national level, In Romania, were registered 4 150 361 hospitalization episodes, from which 975 504 were surgical cases. According to inclusion criteria, 14 641 cases had undergone elective surgery. Based on the 10-hospital sample, the measured weighted mean complication costs per case ranged from EUR 1 046.73 to EUR 3 564.56 for stroke and sepsis with pneumonia respectively. The health economic model simulated two scenarios. In the first scenario all cases with anemia received FCM treatment. The national level total savings were at least EUR 2 112 280. In the second scenario, which is closer to the real-life practice, half of cases with anemia received treatment. Total savings were at least EUR 319 191.

CONCLUSIONS: Results suggest that introducing anemia treatment with FCM in case of elective surgical interventions saves costs for the healthcare system. If PBM would be extended to other elective interventions, the benefits could be even higher.