Cost Effectiveness and Budget Impact of Patient Blood Management in a Turkish State Hospital

OBJECTIVES: Anemia and transfusion of blood products are risk factors associated with poor patient outcomes across all elective surgeries. Patient Blood Management (PBM) focuses on optimizing the patient’s own blood through evidence-based approaches. The objective of this study is to explore the cost-effectiveness and budget impact of implementing PBM in the cardiovascular surgery department of a state hospital in Turkey.

METHODS: A cost-effectiveness (decision tree) and budget impact model, based on number of avoided red blood cell (RBC) transfusions and complications before and after the implementation of the program was developed. The endpoints of the cost-effectiveness study were avoided transfusion-related complications (sepsis, renal failure, myocardial infarction, and stroke), and results were presented as incremental cost per incremental avoided complication. Blood usage data were obtained from the transfusion center of the hospital from February 2019 to October 2020 (pre-PBM) and December 2020 to July 2022 (post-PBM). Results of recent meta-analyses were used for probabilities of transfusion and complications after transfusion. The major cost parameters in the model were cost of PBM, cost of transfusion and cost of treating complications. Costs were estimated from the Turkish healthcare payer perspective (SSI).

RESULTS: There was a 21% decrease in the use of RBC after the implementation of the program. This decrease alone saved 1,635,948 TRY. In the cost-effectiveness model, implementation of PBM was estimated to avoid 68 complications. The post-PBM period dominated the pre-PBM period. The hospital saved 8,232,882 TRY (404,725€) in the given period by avoiding transfusions and complications. Sensitivity analysis results have showed that the findings of the study were robust.

CONCLUSIONS: This study from a hospital in Turkey indicates that PBM is a cost-effective and budget saving approach. Broadening the program to other surgical departments of the hospital and to other state hospitals is recommended to the SSI.