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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Article info
Publication history
Published online: August 30, 2021
Accepted:
July 22,
2021
Identification
Copyright
© 2021 International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc.
