OBJECTIVES: To assess the economic implications of increasing the usage of calcium free balanced solutions (BAL) for IV fluid therapy on costs of fluids in SIRS patients from a Brazilian public hospital perspective.

METHODS:Model framework: An Excel®-based budget impact model was developed to assess the impact of increased usage of BAL in SIRS patients versus current 0.9% saline usage on the costs of IV fluids and fluid-related complications. The base case was defined as a 918-bed hospital with 83% occupancy and 23% SIRS frequency. Population: Patients aged ≥18 years meeting SIRS criteria (presence of a: tachycardia: pulse over 90 bpm and any of b: Temperature: >38°C or <36°C; c: ≥20 breaths/minute; or d: PaCO2 ≤32 mmHg and leukocytes ≥12,000 or ≤4,000 cells/mm) and receiving solely crystalloid IV fluids. Adoption rate: exponential over a 5-year period. Model input parameters (BAL: 0-20%): SIRS and complication frequencies were based on clinical outcomes per literature. Costs were based on DATASUS, Diagnosis Related Group Handbook and medical literature, savings related to medication and 72h fluid replacement. Overall savings were calculated by subtracting complication and treatment costs associated with BAL adoption level per year from costs associated with 0.9% saline adoption level, and adding incremental costs.

RESULTS:Patients/month meeting SIRS criteria and requiring fluid resuscitation calculated was 644. Cumulative pharmacy savings were estimated to be R$30,197 by year 1, and R$501,636 by year 5. The 72h fluid cost increased from R$7,089 (current) to R$22,067 (year 5). These costs represented 2.52% and 8.30%, respectively, from total costs related to fluid usage and medications. On the other hand, all other cost channels (length of stay, medication, procedures, professional services and diagnostics) were reduced.

CONCLUSIONS:The 72h fluid consumption in SIRS patients represented less than 10% of pharmacy costs, savings are related to lower incidence of complications.