OBJECTIVES: To compare the total costs associated with using fibrinogen concentrate (FC) versus fresh frozen plasma (FFP) in the treatment of acquired bleeding during cardiac surgery in the Netherlands.

METHODS: A cost calculator model was developed for the Dutch hospital payer perspective using Microsoft^® Excel. Data for dosing, clinical efficacy, and frequency of adverse events were obtained from a retrospective review of clinical trials for both FC and FFP published before March, 2019. Hospital-based cost inputs were obtained from publically available sources for the Netherlands, and included FC, FFP, and other product (red blood cells and platelets) costs, activity-based costs (thawing and preparation time, infusion time, and ABO typing), hospitalisation costs, and costs for treatment of adverse events. Total average costs per patient undergoing treatment with either product were calculated and compared.

RESULTS: Total average cost per patient associated with treatment of bleeding during cardiac surgery was 3,972€ lower (21.1% reduction) with FC-based treatment (14,869€) than with FFP-based treatment (18,841€). Average cost of therapy was higher with FC compared to FFP. Non-ICU hospitalisation costs were higher and ICU hospitalisation costs were lower with FC compared to FFP. Total hospitalisation costs were slightly higher with FC compared to FFP due to the longer non-ICU stay reported for FC in the clinical trial. However, these costs were offset by savings from lower activity-based costs, avoidance of allogeneic blood products, and lower costs associated with treatment of adverse events, including infections, venous thrombosis, ischemic stroke, intracranial haemorrhage, reoperation, transfusion-associated circulatory overload (TACO), and transfusion-related acute lung injury (TRALI).

CONCLUSIONS: The use of FC in the management of bleeding during cardiac surgery in the Netherlands is a cost-saving treatment option when compared with FFP, despite a higher cost of therapy acquisition, due to savings in other hospital-based costs.