Cost-minimising analysis of acute normovolaemic haemodilution and hypervolaemic haemodilution in saving red blood cells as compared to transfusion of allogeneic blood

G. Singbartl, Kai Singbartl, W. Schleinzer, H. Munkel

Research output: Contribution to journalArticle

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Abstract

Background: Analysing cost data with respect to savings of red blood cells (rbc) by acute normovolaemic haemodilution (ANH) / hypervolaemic haemodilution (HHD) versus purchasing homologous packed rbc (HPRBC). Methods: Using our previously published model for ANH/HHD we calculated saving of rbc mass for various initial (45 and 40%) and minimal (haematocrit) hct levels (27, 24, 21 and 18%). ANH was performed by isovolaemic exchange of 4 units of blood (each 500 ml) versus colloid with an intravascular volume effect of 1.0. Intra-operative loss of colloid was only due to surgical blood loss. ANH units were re-transfused in reverse order; thereby maintaining isovolaemia and minimal hct level with ongoing blood loss by additional infusion of colloid. HHD was performed by pre-operative infusion of 1,000 ml colloid; assumed intravascular volume effect is 1.0. Hypervolaemia during surgical blood loss was maintained by infusion of colloid until reaching minimal hct. Elimination of the excessive colloid from the intravascular space lead to rise in hct (from minimal to final hct). This difference between final and minimal hct results in saving of rbc mass. Cost data refer to both hospital variable/acquisition cost and data given in DKG-NT (variable/acquisition cost ('Sachkosten') and total cost ('Gesamtkosten')). Results: ANH at the best allows for rbc mass savings of approximately 2 units (each 190 ml of rbc). Under less ideal conditions (initial hct ≤ 40%, minimal hct ≥ 21%), rbc savings amount to approximately 1 unit. With HHD, the corresponding rbc mass saved amounts up to 1 unit at best. Our cost-minimising analysis (CMA) shows that these rbc savings by ANH/HHD are less expensive than purchasing equal amounts of allogeneic rbc mass. With respect to the underlying cost base, these 2 units are between 25% (total cost according to DKG-NT: ANH EUR 166.5 versus HPRBC EUR 221.1) and 60% (hospital variable cost: ANH EUR 61.7 versus HPRBC EUR 157.2) cheaper than corresponding units of HPRBC. rbc mass saved by HHD is even less expensive (total cost according to DKG-NT: HHD EUR 63.8 versus HPRBC EUR 135.1; hospital variable cost EUR 32.1 versus HPRBC EUR 95.2). Thus, they are approximately 53% (total cost according to DKG-NT) to 62% (hospital variable cost) less expensive than HPRBC. Conclusions: Both ANH and HHD - under ideal conditions and within their limited extent - are more cost-effective in saving rbc than transfusion of allogeneic blood. However, both the efficacy of these measures and the resulting financial savings are limited at best to 2 units of rbc for ANH and 1 unit for HHD.

Original languageEnglish (US)
Pages (from-to)262-268
Number of pages7
JournalInfusionstherapie und Transfusionsmedizin
Volume27
Issue number5
StatePublished - Dec 12 2000

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cost analysis
Hemodilution
Blood Transfusion
erythrocytes
Erythrocytes
Costs and Cost Analysis
blood
colloids
Erythrocyte Volume
Colloids
variable costs
Hospital Costs
purchasing
Surgical Blood Loss
hematocrit
Erythrocyte Transfusion

All Science Journal Classification (ASJC) codes

  • Food Science
  • Immunology
  • Hematology

Cite this

@article{2fb2881e724041aaa1a90c285b19fb33,
title = "Cost-minimising analysis of acute normovolaemic haemodilution and hypervolaemic haemodilution in saving red blood cells as compared to transfusion of allogeneic blood",
abstract = "Background: Analysing cost data with respect to savings of red blood cells (rbc) by acute normovolaemic haemodilution (ANH) / hypervolaemic haemodilution (HHD) versus purchasing homologous packed rbc (HPRBC). Methods: Using our previously published model for ANH/HHD we calculated saving of rbc mass for various initial (45 and 40{\%}) and minimal (haematocrit) hct levels (27, 24, 21 and 18{\%}). ANH was performed by isovolaemic exchange of 4 units of blood (each 500 ml) versus colloid with an intravascular volume effect of 1.0. Intra-operative loss of colloid was only due to surgical blood loss. ANH units were re-transfused in reverse order; thereby maintaining isovolaemia and minimal hct level with ongoing blood loss by additional infusion of colloid. HHD was performed by pre-operative infusion of 1,000 ml colloid; assumed intravascular volume effect is 1.0. Hypervolaemia during surgical blood loss was maintained by infusion of colloid until reaching minimal hct. Elimination of the excessive colloid from the intravascular space lead to rise in hct (from minimal to final hct). This difference between final and minimal hct results in saving of rbc mass. Cost data refer to both hospital variable/acquisition cost and data given in DKG-NT (variable/acquisition cost ('Sachkosten') and total cost ('Gesamtkosten')). Results: ANH at the best allows for rbc mass savings of approximately 2 units (each 190 ml of rbc). Under less ideal conditions (initial hct ≤ 40{\%}, minimal hct ≥ 21{\%}), rbc savings amount to approximately 1 unit. With HHD, the corresponding rbc mass saved amounts up to 1 unit at best. Our cost-minimising analysis (CMA) shows that these rbc savings by ANH/HHD are less expensive than purchasing equal amounts of allogeneic rbc mass. With respect to the underlying cost base, these 2 units are between 25{\%} (total cost according to DKG-NT: ANH EUR 166.5 versus HPRBC EUR 221.1) and 60{\%} (hospital variable cost: ANH EUR 61.7 versus HPRBC EUR 157.2) cheaper than corresponding units of HPRBC. rbc mass saved by HHD is even less expensive (total cost according to DKG-NT: HHD EUR 63.8 versus HPRBC EUR 135.1; hospital variable cost EUR 32.1 versus HPRBC EUR 95.2). Thus, they are approximately 53{\%} (total cost according to DKG-NT) to 62{\%} (hospital variable cost) less expensive than HPRBC. Conclusions: Both ANH and HHD - under ideal conditions and within their limited extent - are more cost-effective in saving rbc than transfusion of allogeneic blood. However, both the efficacy of these measures and the resulting financial savings are limited at best to 2 units of rbc for ANH and 1 unit for HHD.",
author = "G. Singbartl and Kai Singbartl and W. Schleinzer and H. Munkel",
year = "2000",
month = "12",
day = "12",
language = "English (US)",
volume = "27",
pages = "262--268",
journal = "Transfusion Medicine and Hemotherapy",
issn = "1660-3796",
publisher = "S. Karger AG",
number = "5",

}

Cost-minimising analysis of acute normovolaemic haemodilution and hypervolaemic haemodilution in saving red blood cells as compared to transfusion of allogeneic blood. / Singbartl, G.; Singbartl, Kai; Schleinzer, W.; Munkel, H.

In: Infusionstherapie und Transfusionsmedizin, Vol. 27, No. 5, 12.12.2000, p. 262-268.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cost-minimising analysis of acute normovolaemic haemodilution and hypervolaemic haemodilution in saving red blood cells as compared to transfusion of allogeneic blood

AU - Singbartl, G.

AU - Singbartl, Kai

AU - Schleinzer, W.

AU - Munkel, H.

PY - 2000/12/12

Y1 - 2000/12/12

N2 - Background: Analysing cost data with respect to savings of red blood cells (rbc) by acute normovolaemic haemodilution (ANH) / hypervolaemic haemodilution (HHD) versus purchasing homologous packed rbc (HPRBC). Methods: Using our previously published model for ANH/HHD we calculated saving of rbc mass for various initial (45 and 40%) and minimal (haematocrit) hct levels (27, 24, 21 and 18%). ANH was performed by isovolaemic exchange of 4 units of blood (each 500 ml) versus colloid with an intravascular volume effect of 1.0. Intra-operative loss of colloid was only due to surgical blood loss. ANH units were re-transfused in reverse order; thereby maintaining isovolaemia and minimal hct level with ongoing blood loss by additional infusion of colloid. HHD was performed by pre-operative infusion of 1,000 ml colloid; assumed intravascular volume effect is 1.0. Hypervolaemia during surgical blood loss was maintained by infusion of colloid until reaching minimal hct. Elimination of the excessive colloid from the intravascular space lead to rise in hct (from minimal to final hct). This difference between final and minimal hct results in saving of rbc mass. Cost data refer to both hospital variable/acquisition cost and data given in DKG-NT (variable/acquisition cost ('Sachkosten') and total cost ('Gesamtkosten')). Results: ANH at the best allows for rbc mass savings of approximately 2 units (each 190 ml of rbc). Under less ideal conditions (initial hct ≤ 40%, minimal hct ≥ 21%), rbc savings amount to approximately 1 unit. With HHD, the corresponding rbc mass saved amounts up to 1 unit at best. Our cost-minimising analysis (CMA) shows that these rbc savings by ANH/HHD are less expensive than purchasing equal amounts of allogeneic rbc mass. With respect to the underlying cost base, these 2 units are between 25% (total cost according to DKG-NT: ANH EUR 166.5 versus HPRBC EUR 221.1) and 60% (hospital variable cost: ANH EUR 61.7 versus HPRBC EUR 157.2) cheaper than corresponding units of HPRBC. rbc mass saved by HHD is even less expensive (total cost according to DKG-NT: HHD EUR 63.8 versus HPRBC EUR 135.1; hospital variable cost EUR 32.1 versus HPRBC EUR 95.2). Thus, they are approximately 53% (total cost according to DKG-NT) to 62% (hospital variable cost) less expensive than HPRBC. Conclusions: Both ANH and HHD - under ideal conditions and within their limited extent - are more cost-effective in saving rbc than transfusion of allogeneic blood. However, both the efficacy of these measures and the resulting financial savings are limited at best to 2 units of rbc for ANH and 1 unit for HHD.

AB - Background: Analysing cost data with respect to savings of red blood cells (rbc) by acute normovolaemic haemodilution (ANH) / hypervolaemic haemodilution (HHD) versus purchasing homologous packed rbc (HPRBC). Methods: Using our previously published model for ANH/HHD we calculated saving of rbc mass for various initial (45 and 40%) and minimal (haematocrit) hct levels (27, 24, 21 and 18%). ANH was performed by isovolaemic exchange of 4 units of blood (each 500 ml) versus colloid with an intravascular volume effect of 1.0. Intra-operative loss of colloid was only due to surgical blood loss. ANH units were re-transfused in reverse order; thereby maintaining isovolaemia and minimal hct level with ongoing blood loss by additional infusion of colloid. HHD was performed by pre-operative infusion of 1,000 ml colloid; assumed intravascular volume effect is 1.0. Hypervolaemia during surgical blood loss was maintained by infusion of colloid until reaching minimal hct. Elimination of the excessive colloid from the intravascular space lead to rise in hct (from minimal to final hct). This difference between final and minimal hct results in saving of rbc mass. Cost data refer to both hospital variable/acquisition cost and data given in DKG-NT (variable/acquisition cost ('Sachkosten') and total cost ('Gesamtkosten')). Results: ANH at the best allows for rbc mass savings of approximately 2 units (each 190 ml of rbc). Under less ideal conditions (initial hct ≤ 40%, minimal hct ≥ 21%), rbc savings amount to approximately 1 unit. With HHD, the corresponding rbc mass saved amounts up to 1 unit at best. Our cost-minimising analysis (CMA) shows that these rbc savings by ANH/HHD are less expensive than purchasing equal amounts of allogeneic rbc mass. With respect to the underlying cost base, these 2 units are between 25% (total cost according to DKG-NT: ANH EUR 166.5 versus HPRBC EUR 221.1) and 60% (hospital variable cost: ANH EUR 61.7 versus HPRBC EUR 157.2) cheaper than corresponding units of HPRBC. rbc mass saved by HHD is even less expensive (total cost according to DKG-NT: HHD EUR 63.8 versus HPRBC EUR 135.1; hospital variable cost EUR 32.1 versus HPRBC EUR 95.2). Thus, they are approximately 53% (total cost according to DKG-NT) to 62% (hospital variable cost) less expensive than HPRBC. Conclusions: Both ANH and HHD - under ideal conditions and within their limited extent - are more cost-effective in saving rbc than transfusion of allogeneic blood. However, both the efficacy of these measures and the resulting financial savings are limited at best to 2 units of rbc for ANH and 1 unit for HHD.

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