The Economic Impact of the Use of Two Flowable Hemostatic Matrices in Spinal Surgery in Three European Countries

OBJECTIVES: Spine surgery is a procedure associated with significant perioperative blood loss. Bleeding during spine surgery is often controlled using topical hemostatic agents when it cannot be controlled by conventional methods. The aim of this study is to evaluate the economic impact associated with the use of two flowable hemostatic matrices, Floseal and Surgiflo, from a hospital perspective in Greece, Italy and Spain.

METHODS: An economic model was developed to compare the resource consumption associated with the use of Floseal (5mL) and Surgiflo (8mL) based on the mean number of used items during spinal fusion or refusion. No statistically significant difference in efficacy between the two products was assumed, as supported by the literature. The mean number of used items for each hemostatic agent was extrapolated from a retrospective comparative study of FLOSEAL vs SURGIFLO sourced from the US Premier Hospital database from January 1, 2010–June 30, 2012, while the price of hemostatic matrices was identified from officially awarded tenders. Deterministic and probabilistic sensitivity analyses were performed on all inputs (number of items used and unit costs) to investigate the model robustness.

RESULTS: The use of Surgiflo was associated with savings of €90, €60 and €30 per surgery in Greece, Italy and Spain, respectively, due to the reduced number of items required per surgery (1.21 versus 1.54) and the lower price per mL. The deterministic sensitivity analysis showed Surgiflo being cost-saving in most of the cases. The probabilistic sensitivity analysis demonstrated that SURGIFLO was cost-saving in 89%, 86% and 70% of the 1,000 simulations in Greece, Italy and Spain, respectively.

CONCLUSIONS: In the three countries Surgiflo appears to be a cost-saving solution compared to Floseal due to the optimized number of items used and the reduced price per mL. Results were consistent across sensitivity analyses.