Search

An adequate supply of blood components for patients depends on the population's willingness to donate blood as well as on a well-organized blood donation system. In order to ensure the blood supply, a high expenditure is necessary. The article at hand describes two areas of the use of blood and blood products. First, it considers the application of factor concentrates in haemophiliacs (approximately 3000-4000 patients are regularly in need of treatment). For the German statutory health insurance, the estimated yearly expenses for factor concentrates is approx. 450 million Euros, the average costs per patient and year and per treatment center range between 40,903 and 117,597 Euros. The costs for an immune tolerance therapy (ITT) for patients with inhibitors are estimated to be between 70,300 and 3,800,000 Euros for children, depending on the length of the therapy and the degree of severity. In the second part of the article, the authors outline the status quo of the economic evaluation of cellular blood products and present the results of a German cross-sectional survey on the use of erythrocytes in orthopaedic surgery. Within the scope of this hemotherapy study, the transfusion rates vary considerably within the participating treatment centers [elective hip joint replacement (THR): 17 and 94%]. The average blood loss also differs significantly. Comparing the treatment centers, the calculated blood loss during THR shows considerable differences (median blood loss in treatment center with lowest/treatment center with highest blood loss: 883 ml/2,975 ml). The acceptance of low intraoperative hemoglobin values in the clinics is high and diverse. These differences in transfusion procedures between the treatment centers clearly show the need to take effective action in the area of quality assurance in order to make the most of the existent savings potential. Transparency of treatment processes is a necessary condition for an economic assessment and for optimal resource allocation.

Directed donations are refused by the most transfusion services for some reasons. At first, voluntary donation is questionable when relatives will be used as blood donors. This fact leads to a higher risk of infections compared with a third party donation. In some rare instances, directed donations may be necessary or beneficial for the recipient. In all these cases, donors must be selected according to federal and institute guidelines. Production, storage, administration and distribution of blood products determined for a certain recipient require many personnel, material and logistic energy. These results in higher costs which have to be borne by the recipient himself. Cost of directed donations are in contrast to their benefit and in contrast to more cost-effectiveness.

Preoperative autogenous blood (PAB) deposit programs are expensive. Aside from primary costs of preparing PAB, the user incurs major secondary costs from additional preadmission visits with the surgeon and from excess production, utilization and outdating of PAB (transfer into the allogeneic blood supply is not permitted here). These costs will exceed 200 Mio DM annually, increasing with better acceptance of PAB programs. However, PAB deposits are only indicated if transfusion incidence for the intended elective procedure exceeds 30%. Below that, preoperative, isovolemic hemodilution is considered the method of choice for limiting exposure to allogeneic blood.

During their economic assessment of our medical center, the accountants Ernst & Young recommended staffing levels for our blood bank. Based on this and while applying the effective annual working time of each professional group (donor room personnel: operator/physician/medical technologist), we developed a staffing key for complete preparation and testing of apheresis-platelet concentrates (TAPH): with scheduled complete physical examinations (first-time donor, then annually) 1,500/1,450/2,300 procedures a year are considered an adequate output for the professional groups involved. With routine donor screening, the key is 1,800/1,900/2,300 procedures. This does not include any HLA-related activities. Based on this staffing key, our average personnel costs for TAPH are DM 124.67, or 18.3% of the total costs of such product (DM 681.40).

Preoperative deposition auf autologous blood requires a strenuous effort for its initiation and operation. K.R.A.F.T.A.K.T. (literal translation: strenuous effort) became therefore the acronym for the program realized at this institution; it stands for: K = communication between patient and his physicians (primary care, surgeon, blood banker) R = direction of the program through the primary care physician (who does what, when, where, how and how much of it) A = informed consent of the patient prior to the first donation F = iron supplement (100mg Fe++ daily beginning 2 weeks prior) T = collection, processing, labelling, storage, pretransfusion testing, and release in accordance with GMP and legal requirements A = blood bank reports on the available units to all concerned K = cost control (limited to operations in need of transfusion) T = transfusion of autologous prior to any homologous unit. We report initial experiences and a cost assessment.