Transfusion practice and costs in a reference tertiary pediatric intensive care unit

Abstract

Abstract Introduction: In this study, we aimed to discuss the transfusion-associated costs in view of transfusion practice in the pediatric intensive care unit (PICU) by considering previously well-defined indications of blood transfusions and the evidence-based evaluation for transfusion decision-making in pediatric patients. Materials and Methods: During a year period (January 2017-December 2017) 76 patients, receiving transfusion with blood components along the stay in PICU were included in the study. Transfusion associated costs and total costs for healthcare services for children treated in PICU was collected by using Hospital Information System. Transfusion-associated costs depending on the supplies (such as sets for blood transfusion and apheresis), immunohematological tests and blood transfusion procedures were considered individually and the cost of transfusion was estimated for each patient which was proportioned to the total cost of healthcare services consequently. Results: The proportion of transfusion-associated cost to total cost of healthcare services was found as 3,24%. The medians for hospital cost and transfusion associated cost were 5478.76 euros (IQR=11280.02) and 130.57 euros (IQR=354.86), respectively. A significant strong positive corelation between numbers of transfusions and hospitalization cost of PICU was detected (r:0.674, p<0.01). In our study, although the median values of the patients administered with split blood were lower, no significant difference was found. Conclusion: There are no studies evaluating blood transfusions and costs in pediatric intensive care units in Turkey. More detailed studies are needed to examine transfusion costs and the diversity of blood product transfusions in intensive care units.

Keywords

• pediatric intensive care unit
• blood transfusion
• transfusion cost
• pediatrics

References

1. 1. World Health Organization, Global database on bloodsafety 2011, http://www.who.int/bloodsafety/global_database/GDBS_Summary_Report_2011.pdf; 2011 [accessed June 2011]
2. 2. Teruya J. Red blood cell transfusion in infants and children: Selection of blood products, https://www.uptodate.com/contents/red-blood-cell-transfusion-in-infants-and-children-selection-of-blood-products;2020 [accessed August 2020]
3. 3. Cholette JM, Noronha SA, Seghatchian J et al. Indications for red cell transfusions in pediatric patients. Transfus Apher Sci. 2018;57(3):342-346. doi: 10.1016/j.transci.2018.05.017.
4. 4. Gibson BE, Todd A, Roberts I et al. British Commitee for Standards in Haematology Transfusion Task Force: Writing group. Transfusion guidelines for neonates and older children. Br J Haematol. 2004;124(4):433-53.
5. 5. Goobie SM, Gallagher T, Gross I. Society for the advancement of blood management administrative and clinical standards for patient blood management programs. 4th edition (pediatric version) Pediatric Anesthesia. 2019;29:231–236.
6. 6. Trentino KM, Farmer SL, Swain SG et al. Increased hospital costs associated with red blood cell transfusion. Transfusion. 2015;55(5):1082-9.
7. 7. Leahy MF, Hofmann A, Towler S et al. Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals. Transfusion. 2017;57(6): 1347-1358.
8. 8. Goel R, Cushing MM, Tobian AA. Pediatric Patient Blood Management Programs: Not Just Transfusing Little Adults. Transfus Med Rev. 2016;30(4):235-41.

9. 9. Hofmann A, Ozawa S, Farrugia A et al. Economic considerations on transfusion medicine and patient blood management. Best Pract Res Clin Anaesthesiol. 2013;27(1):59-68.
10. 10. Lacroix J, Hébert PC, Hutchison JS, et al. TRIPICU Investigators; Canadian Critical Care Trials Group; Pediatric Acute Lung Injury and Sepsis Investigators Network. Transfusion strategies for patients in pediatric intensive care units. N Engl J Med. 2007;19;356(16):1609-19.
11. 11. Doctor A, Cholette JM, Remy KE et al. Pediatric Critical Care Transfusion and Anemia Expertise Initiative (TAXI); Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Recommendations on RBC Transfusion in General Critically Ill Children Based on Hemoglobin and/or Physiologic Thresholds From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med. 2018;19(9S Suppl 1):S98-S113.
12. 12. Hébert PC, Wells G, Blajchman MA et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999;11;340(6):409-17.
13. 13. Carson JL, Stanworth SJ, Roubinian N et al. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. 2016;12;10(10):CD002042.
14. 14. M. E. Açık, H. Ş. Türk, C. T. Işıl et al. Frequency and threshold of the erythrocyte suspension transfusion in the intensive care unit. Med Bull Sisli Etfal Hosp. 2014; 48(4): 291-295
15. 15. Lackritz EM, Hightower AW, Zucker JR et al. Longitudinal evaluation of severely anemic children in Kenya: the effect of transfusion on mortality and hematologic recovery. AIDS. 1997;11(12):1487-94.
16. 16. Williams GD, Bratton SL, Ramamoorthy C. Factors associated with blood loss and blood product transfusions: a multivariate analysis in children after open-heart surgery. Anesth Analg. 1999;89(1):57-64.
17. 17. Crémieux PY, Barrett B, Anderson K et al. Cost of outpatient blood transfusion in cancer patients. J ClinOncol 2000;18(14): 2755-61.
18. 18. Agrawal S, Davidson N, Walker M et al. Assessing the total costs of blood delivery to hospital oncology and haematology patients. CurrMedResOpin 2006;22(10): 1903-9.
19. 19. Janssen MP, van Tilborgh AJW, de Vooght KM et al. Direct costs of transfusion reactions - an expert judgement approach. Vox Sang. 2018;113(2):143-151.
20. 20. Oge T, Kilic CH, Kilic GS. Economic impact of blood transfusions: balancing cost and benefits. Eurasian J Med. 2014;46(1):47-9.
21. 21. Kleinerüschkamp AG, Zacharowski K, Ettwein C et al. Costanalysis of patient blood management. Anaesthesist. 2016 Jun;65(6):438-48.
22. 22. Decadt I, Costermans E, Van de Poel M et al. A haemovigilance team provides both significant financial and quality benefits in a University Hospital. Transfus Apher Sci. 2017;56(2):199-205.