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Is the Decision to Use Transfusion Alternatives Driven by Reimbursement or Medical Need?

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asked May 17, 2012 in Conditions and Treatments by Jan B. Wade (4,930 points)
retagged Jun 4, 2012 by LarryEitel
Transfusions from stored donor blood is a big business as doctors own parts of or stock in blood banks, so of course they want you to use donor blood.  I don't care about their wallet, but instead care about my safety, so I choose non blood management.

3 Answers

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Driven mainly by medical need however it is more than cost effective

from my copy of The Oncologist®

"Five Drivers Shifting the Paradigm from Product-Focused
Transfusion Practice to Patient Blood Management

The objective of this paper is to introduce clinicians and
health care professionals to the concept of patient blood
management (PBM) and to explain the difference between
PBM and the concept of “appropriate use” of blood products.
The five reasons why modern health systems need to
shift from product-focused transfusion practice to PBM
are also presented. These are: the aging population with a
leveraged demand for blood products opposed to a shrinking
donor base; the growing awareness that transfusion is
a complex service involving many different cost centers
within a hospital and representing a multiple of the blood
product cost; the continuous effort to protect blood pools
from known, new, or re-emerging pathogens
while facing
uncertainty over their potentially long silent carrier states;
the emerging evidence that transfusion is an independent
risk factor for adverse outcomes
; and finally, a lack of evidence
for benefit of transfusion for the vast majority of recipients
The Oncologist 2011;16(suppl 3):3–11"

answered May 17, 2012 by pnutts (1,820 points)
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In a recent article about the seeming increase of blood use for treatment of End Stage Renal Disease (written and posted on The Bloody Truth blog), Dr. Carolyn Burns made the following comment:

"So, if indeed we are beginning to see an increase in transfusion in patients with ESRD, this may be a reflection of the regulatory and reimbursement changes as noted."

Let us never forget that in the West the bottom line is the bottom line.  When reimbursement changes so does the use of drugs and services.  We must realize and work within the system however as blood management professionals we must do what we can to resist dollar driven treatment decisions.

So the answer to the original question is sometimes as in 'Sometimes the decision to use or not use a transfusion alternative is based on reimbursement'.  If the institution is forced to absorb the cost of anemia treatment and must chose between spending $4,500 or $1200 the pressure will be toward the lower figure.  EPO and Iron, etc = $4,500, PRBC's = $1200.  (Figures do not necessarily reflect current market)

Read the entire article here

answered May 24, 2012 by Jan B. Wade (4,930 points)
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In 2011, when I was hospitalized, I was offered blood for my condition and turned it down. Two doctors tried for two days to make me take the blood, claiming I had cancer in my colon, although all my blood tests showed clean organs...there was no blood in my stool. Nurses were sent to me that were case managers and they told me they were sending me home with a 5.6 hemoglobin because my hospital stay was not cost effective. My blood count was so low (3.8), a specialist told me I would have died with just the anaesthesia used for the colonoscopy, much less if they had cut a specimen from my colon...I just didn't have enough blood.The hospital allows blood transfusion patients to stay until they reach a 9.0 hemoglobin.
answered Mar 27, 2013 by 21stCentury (630 points)

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