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Economic Evaluation of National Patient Blood Management Clinical Guidelines in Cardiac Surgery

Published:August 30, 2021DOI:https://doi.org/10.1016/j.jval.2021.07.014

      Highlights

      • Clinical guidelines are a common intervention in the healthcare sector designed to improve the quality and consistency of care. Nevertheless, unlike other healthcare interventions they are not usually assessed for their economic efficiency. This can be done by performing an economic evaluation comparing the cost of development with subsequent changes in practice.
      • Previous research has shown that patient blood management guidelines are effective at reducing unnecessary blood transfusions. This article determines whether developing such guidelines are an efficient use of resources by comparing the cost of developing a set of national clinical guidelines with estimated changes in resource use.
      • This article highlights that developing and publishing high quality clinical guidelines can positively influence practice and be a cost saving intervention if the guideline’s recommendations pertain to a reduction in resource use.

      Abstract

      Objectives

      To the best of our knowledge, no published clinical guidelines have ever undergone an economic evaluation to determine whether their implementation represented an efficient allocation of resources. Here, we perform an economic evaluation of national clinical guidelines designed to reduce unnecessary blood transfusions before, during, and after surgery published in 2012 by Australia’s sole public blood provider, the National Blood Authority (NBA).

      Methods

      We performed a cost analysis from the government perspective, comparing the NBA’s cost of implementing their perioperative patient blood management guidelines with the estimated resource savings in the years after publication. The impact on blood products, patient outcomes, and medication use were estimated for cardiac surgeries only using a large national registry. We adopted conservative counterfactual positions over a base-case 3-year time horizon with outcomes predicted from an interrupted time-series model controlling for differences in patient characteristics and hospitals.

      Results

      The estimated indexed cost of implementing the guidelines of A$1.5 million (2018-2019 financial year prices) was outweighed by the predicted blood products resource saving alone of A$5.1 million (95% confidence interval A$1.4 million-A$8.8 million) including savings of A$2.4 million, A$1.6 million, and A$1.2 million from reduced red blood cell, platelet, and fresh frozen plasma use, respectively. Estimated differences in patient outcomes were highly uncertain and estimated differences in medication were financially insignificant.

      Conclusions

      Insofar as they led to a reduction in red blood cell, platelet, and fresh frozen plasma use during cardiac surgery, implementing the perioperative patient blood management guidelines represented an efficient use of the NBA’s resources.

      Keywords

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