OBJECTIVES: To estimate the cost-effectiveness and budget impact (BI) of increasing the usage of calcium free balanced solutions (BAL) for IV fluid therapy instead of 0.9% saline in major surgical patients from a Brazilian private hospital perspective.

METHODS: Model framework: An Excel®-based decision tree model was developed with the following events: mechanical ventilation, hemodialysis and death. This model was adapted for a 105-Operating Room (OR) bed hospital from São Paulo, Brazil. Target population: surgical patients undergoing major procedures requiring fluid resuscitation, representing 12,690 patients per year. Model input parameters: a systematic review was conducted to evaluate surgical complication frequencies. Costs were based on DATASUS, CMED and medical literature. The BI analysis had a horizon of 5 years, while cost-effectiveness analysis considered 30 days horizon with no discount rates. Probabilistic sensitivity analyses were performed to explore parametric uncertainties.

RESULTS: Treatment with BAL dominates 0.9% saline treatment, being less expensive (- US$ 1,826,901) and more effective (386 avoided deaths) in 12,690 patients. Considering all costs, BI results in progressive savings of US$ - 18,258.00 by year 1, and US$ - 182,589.00 by year 5. Regarding only crystalloids acquisition costs there was an increasing from US$ 15,717.00 in year 1 to US$ 157,177.00 in year 5. However, acquisition costs were compensated by savings in complication costs.

CONCLUSIONS: surgical complications are main drivers to increased costs. The IV fluid choice impacts directly on the frequency of complications and costs. In this analysis, it has been demonstrated that BAL usage is potentially a cost-saving decision, which impacts the institutional budget in a positive way. Savings could be explained by lower incidence of complications, especially hemodialysis and avoided death episodes.