Thread: Cost implications of post-surgical morbidity following blood transfusion in cancer pa

Journal:
Curr Med Res Opin. 2005 Mar;21(3):447-56

Full Text Article Link:
http://tinyurl.com/592kr


Cost implications of post-surgical morbidity following blood transfusion in cancer patients undergoing elective colorectal resection: an evaluation in the US hospital setting.


Guest JF, Ruiz FJ, Tang R, Wang JY, Changchien CR, Wexner S, Choti MA.

CATALYST Health Economics Consultants, Northwood, UK.

OBJECTIVE: To estimate the cost implications of blood transfusions and related surgical site infections (SSIs) in cancer patients undergoing elective colorectal resection in the hospital setting in the United States (US). Study design: A modelling study was performed from the perspective of the hospital sector, based on published clinical outcomes from a study in Taiwan involving 2809 cancer patients who underwent elective colorectal resection using laparotomy and American treatment patterns. METHODS: Data on resource use were retrieved from published literature and from two American hospital centres specialising in colorectal cancer management. Decision analytical modelling was used to estimate the treatment costs and consequences of managing patients undergoing elective colorectal resection with and without blood transfusions. RESULTS: The expected treatment costs of managing patients who required and did not require a blood transfusion were estimated to be $19 869 (95% CI: 15 797; 23 150) and $14 586 (95% CI: 14 263; 14 886) per patient respectively. Expected treatment costs for those patients transfused with 1-3 units and > 3 units of blood were estimated to be $17 449 and $22 588 per patient respectively. CONCLUSION: This is one of the first studies to specifically address the cost implications of postsurgical morbidity following colorectal resection in cancer patients. The cost of managing cancer patients undergoing elective colorectal resection who require a blood transfusion is expected to be 36% more than that of non-transfused patients, largely resulting from the development of SSIs.

PMID: 15811214 [PubMed - in process] http://tinyurl.com/6q7j5

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Effects of Allogeneic Red Blood Cell Transfusions on Clinical Outcomes in Patients Undergoing Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis

Annals of Surgery:
August 2012 - Volume 256 - Issue 2 - p 235–244
doi: 10.1097/SLA.0b013e31825b35d5
Meta-Analyses

Abstract

Objective: To determine the effect of allogeneic blood transfusion (ABT) on clinical outcomes in patients with colorectal cancer undergoing surgery.
Background: Perioperative ABTs may be associated with adverse clinical outcomes.
Methods: Systematic review of the literature with odds ratio (OR) and incidence rate ratio (IRR) meta-analyses of predefined clinical outcomes based on a MEDLINE search.
Results: In total, 20,795 colorectal cancer (CRC) patients observed for more than 59.2 ± 26.1 months (108,838 patient years) were included, of which 58.8% were transfused. ABT was associated with increased all-cause mortality OR = 1.72 (95% confidence interval [CI] 1.55 − 1.91, P < 0.001); I² = 23.3% (0 − 51.1) and IRR = 1.31 (1.23 − 1.39, P < 0.001), I² = 0.0% (0 − 37.0). ABT was also associated with increased ORs (95% CI, P) for cancer-related mortality of 1.71 (1.43 − 2.05, P <0.001), combined recurrence—metastasis—death 1.66 (1.41 − 1.97, P < 0.001), postoperative infection 3.27 (2.05 − 5.20, P < 0.001), and surgical reintervention 4.08 (2.18 − 7.62, <0.001). IRR (95% CI, P) was 1.45 (1.26 − 1.66, <0.001) for cancer-related mortality and 1.32 (1.19 − 1.46, <0.001) for recurrence—metastasis—death. Mean length of hospital stay was significantly longer in transfused compared with nontransfused patients (17.8 ± 4.8 vs 13.9 ± 4.7 days, P = 0.005).
Conclusions: In patients with colorectal cancer (CRC) undergoing surgery, ABTs are associated with adverse clinical outcomes, including increased mortality. Measures aimed at limiting the use of ABTs should be investigated further.