OBJECTIVES:

Patient blood management (PBM) is a patient-centered, evidence-based, multidisciplinary approach aimed at optimizing hemoglobin concentration, ensuring the continuity of hemostasis and minimizing blood loss in patients undergoing surgery. The aims of this study were: (1) to understand if the management of anemia (the first pillar of PBM) with intravenous (IV) ferric carboxymaltose (FCM) is cost-effective in patients undergoing hip and knee surgery or cardiac surgery from the perspective of the Turkish Social Security Institution (SSI’s); and (2) to explore the potential cost savings of implementing PBM measures for the SSI.

METHODS:

Cost-effectiveness and budget impact models were developed based on the avoidance of postoperative adverse events following implementation of pre-operative anemia measures with FCM for non-cardiac and cardiac surgical patients. The probabilities of adverse events (sepsis with and without pneumonia, renal failure, myocardial infarction and stroke) were taken from a recently published meta-analysis and the costs of treating these adverse events for the SSI were estimated through expert opinions and the use of SSI guidelines.

RESULTS:

The first pillar of PBM implementation, diagnosis and treatment of anemia in patients before elective surgery, dominated the control arm for both non-cardiac and cardiac surgeries. The cost-effectiveness results were associated with improved outcomes and lower costs (1768 and 1244 avoided adverse events and cost reductions of 11411 Turkish lira [TRY] and 9302 TRY for non-cardiac and cardiac surgeries, respectively). The budget impact analysis showed that the use of FCM can bring about potential cost-savings for the SSI regarding the five types of adverse events, with savings of up to 299,267,808 TRY (€18,459,875) for hip and knee arthroplasty and 35,210,435 TRY (€2,171,901) for CABG surgery.

CONCLUSIONS:

The implementation of the first pillar of PBM, via the use of FCM, is a cost-effective and cost-saving option for cardiac and non-cardiac surgery in Turkey.