Blood InflationBlood Inflation

Karen L. Dallas, M.D.C.M.TMR Journal Club

May 4, 2010

“Activity-Based Costs of Blood Transfusions in Surgical

Patients at Four Hospitals”~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Transfusion April 2010. Vol 50(4), 753-765.

About me…About me…

American (from Minnesota!)McGill Medical SchoolU of T – Hematopathology ResidencyBloodCenter of Wisconsin Fellowship in

Transfusion/Coagulation + Research

…then back to Canada!

ObjectivesObjectives

Why this article?

Relevant background information

Article Review

Critical Appraisal

Discussion (the “meat & potatoes” of this JC!)

Why? Why? (at least (at least somesome of it!) of it!)

>14 million units collected annually in US>1 million in Canada

Previous cost estimates ~$300-700 US Studies/methods imperfect at best

Economic decision-making is increasingly important

Canadian SituationCanadian Situation

1994 – Mean cost per unit RBC transfused in Canada was reported at $152.17 US

CBS/HQ paper (Transfusion, 2004) re-visited issue:

Total $264.81 US Collection, production, distribution = $202.74 Donor time = $18.21 Hospital processing = $16.65 Actual transfusion = $26.92 Acute reaction management = $0.29

Accounting 101Accounting 101

Costing a.k.a. Cost Accounting type of accounting process which aims to

capture costs of production most beneficial as a tool for management in

budgeting and setting up cost control programs

Traditional CostingVS.

Activity-Based Costing (ABC)

Entire 136-page OCCI Guide…

0 entries for transfusion or blood!!

MethodsMethods

Main Processes in Transfusion ChainMain Processes in Transfusion Chain

Flow Diagram (YIKES!)

Formulas… Formulas… (YIKES!)(YIKES!)

Costs of Acquisition and Costs per Unit

Are the results valid? In this case, I think we can safely say, “Yes!”

What are the results? These results show the cost of blood – in US and

European settings alike – to be much higher than previously reported. They also demonstrate the amount of “overhead”cost inherent to hemotherapy.

How can we apply the results to patient care? This is the subject of our discussion…

DiscussionDiscussionA few starter questions…A few starter questions…

Is ABC worthwhile? Idea of LEAN Accounting…

Should we re-visit the cost of Blood Center Production?

What are we to do with this information? Blood conservation, blood alternatives, etc. Transfusion is life-saving…are all “costs”

created equally?

Thank-you!Thank-you!

Dr. Skeate

andCBS Medical Office, Toronto

Dr. Fernandes, U of T Hematopathology