PMID- 17764560
OWN - NLM
STAT- MEDLINE
DCOM- 20071210
LR  - 20181201
IS  - 1472-6963 (Electronic)
IS  - 1472-6963 (Linking)
VI  - 7
DP  - 2007 Aug 31
TI  - Effect of a restrictive transfusion strategy on transfusion-attributable severe 
      acute complications and costs in the US ICUs: a model simulation.
PG  - 138
AB  - BACKGROUND: Nearly half of all patients in the Intensive Care Unit (ICU) receive 
      red blood cell (pRBC) transfusions (TFs), despite their associated complications. 
      Restrictive transfusion strategy (Hemoglobin [Hb] < 7 g/dL) has been shown to 
      reduce TF exposure. We estimated the potential annual reduction in 
      transfusion-attributable severe acute complications (TSACs) and costs across the 
      US ICUs with the adoption of restrictive strategy. METHODS: A model, utilizing 
      inputs from published studies, was constructed. Step 1 calculated potential 
      number of patients appropriate for this strategy. In step 2, total number of pRBC 
      units avoided with the restrictive trigger was extrapolated to the annual TFs in 
      the US ICUs. Step 3 quantified excess acute complications and the number of pRBC 
      units TF/1 TSAC in the TRICC trial. Step 4 transformed restrictive 
      strategy-related avoidance of pRBC units to a reduction in TSACs, and step 5 
      quantified the associated cost savings. RESULTS: Of the 4.4 million annual ICU 
      admissions, 1,020,800 comprised the at-risk population. The total of 1,295,126 
      units of pRBC ($643/unit) could be saved with the restrictive strategy. Based on 
      the data from the TRICC trial, dividing the 49 excess complications in the 
      liberal group into the calculated excess of pRBCs transfused (1,624 units) 
      yielded the rate of 33 pRBC units per one complication. Thus, dividing 1,295,126 
      units saved by 33 units/1 TSAC, the base-case analysis showed that 39,246 TSACs 
      could potentially be avoided annually in the US ICUs, with the cost savings of 
      $821,109,826. CONCLUSION: This model demonstrates that a restrictive transfusion 
      strategy in appropriate at risk ICU patients is dominant and could result in 
      improved quality of care and cost savings. Given the potential savings of 40,000 
      TSACs and nearly $1 billion, it is incumbent upon the intensivist community to 
      promote more ubiquitous adoption of a clinically appropriate restrictive 
      transfusion strategy in the ICU.
FAU - Zilberberg, Marya D
AU  - Zilberberg MD
AD  - University of Massachusetts, 715 North Pleasant Street, Amherst, MA 01003, USA. 
      MZilberb@schoolph.umass.edu
FAU - Shorr, Andrew F
AU  - Shorr AF
LA  - eng
PT  - Journal Article
DEP - 20070831
PL  - England
TA  - BMC Health Serv Res
JT  - BMC health services research
JID - 101088677
SB  - IM
MH  - Adult
MH  - Aged
MH  - Bibliometrics
MH  - Computer Simulation
MH  - Cost Savings/*methods
MH  - Erythrocyte Transfusion/*adverse effects/economics/*statistics & numerical data
MH  - Female
MH  - Health Policy
MH  - Humans
MH  - Iatrogenic Disease/epidemiology/*prevention & control
MH  - Intensive Care Units/economics/*standards
MH  - Male
MH  - Middle Aged
MH  - *Models, Econometric
MH  - Monte Carlo Method
MH  - *Organizational Policy
MH  - Quality Assurance, Health Care/*methods
MH  - Risk Assessment/methods
MH  - United States/epidemiology
PMC - PMC2064919
EDAT- 2007/09/04 09:00
MHDA- 2007/12/11 09:00
PMCR- 2007/08/31
CRDT- 2007/09/04 09:00
PHST- 2007/05/12 00:00 [received]
PHST- 2007/08/31 00:00 [accepted]
PHST- 2007/09/04 09:00 [pubmed]
PHST- 2007/12/11 09:00 [medline]
PHST- 2007/09/04 09:00 [entrez]
PHST- 2007/08/31 00:00 [pmc-release]
AID - 1472-6963-7-138 [pii]
AID - 10.1186/1472-6963-7-138 [doi]
PST - epublish
SO  - BMC Health Serv Res. 2007 Aug 31;7:138. doi: 10.1186/1472-6963-7-138.