==================================HSR16================================== 16. Blood product utilization in U.S. hospitals: 1981-1984; specifically whole blood, red blood cells, platelets, cryoprecipitate, fresh frozen plasma. Dollar volume purchase of above products. 1 UI - 87027920 AU - Kramer MS ; Mills EL ; MacLellan AM ; Coates PJ TI - Effects of obtaining a blood culture on subsequent management of young febrile children without an evident focus of infection. AB - To assess the effects of obtaining a blood culture on the subsequent diagnostic and therapeutic management of young febrile children without an evident focus of bacterial infection, we carried out a randomized controlled clinical trial of this procedure in 146 children 3 to 24 months of age who presented to our emergency department with an unexplained temperature of 39.0 degrees C or higher. Random assignment to either have (67 children) or not have (79) a blood sample taken for culture resulted in groups equivalent in age, sex, weight, socioeconomic status, temperature at enrolment and laboratory test results. No differences were detected in the rates of subsequent hospital admission, outpatient visits, determination of complete blood count or other blood tests, urinalysis or urine culture, chest or other roentgenography, or administration of antibiotics or other medications. Knowledge of the absence of such differences should be helpful in evaluating the relative benefits and costs of blood culture for young febrile children. MH - Ambulatory Care Facilities/UTILIZATION ; Antibiotics/THERAPEUTIC USE ; Blood/*MICROBIOLOGY ; Child Health Services/*UTILIZATION ; Child, Preschool ; Clinical Trials ; Costs and Cost Analysis ; Diagnosis, Laboratory/UTILIZATION ; *Diagnostic Tests, Routine/ECONOMICS ; Emergency Service, Hospital ; Female ; Fever/*ETIOLOGY ; Follow-Up Studies ; Hematologic Tests/UTILIZATION ; Hospitalization/UTILIZATION ; Human ; Infant ; Male ; Physician's Practice Patterns ; Quebec ; Random Allocation ; Septicemia/DIAGNOSIS ; Support, Non-U.S. Gov't SO - Can Med Assoc J 1986 Nov 15;135(10):1125-9 2 UI - 86310050 AU - Wantzin P ; Skovgaard L ; Tygstrup N ; Nielsen JO ; Soerensen H ; Dybkjaer E TI - Cost-effectiveness of introducing a third-generation test for HBsAg in Danish blood donors. AB - Owing to the low incidence of hepatitis B in Denmark, screening of blood donors for HBsAg has mostly been done by immunoelectroosmophoresis (IEOP). The purpose of the present study was to carry out a cost-effectiveness analysis prior to the introduction of a third-generation test for HBsAg in Danish blood donors. The analysis was performed on data from a subsequent screening of 48 750 blood units by radioimmunoassay (RIA) 3 weeks after donation. The RIA-pos., IEOP-neg. blood donors identified in the study were evaluated by a follow-up examination, and the recipients of RIA-pos., IEOP-neg. blood units were monitored for up to 9 months as to the development of acute hepatitis B. The study shows that the estimated cost for each prevented case of transfusion-associated hepatitis B in Denmark is US$ 1100 when screening donors not previously tested by a third-generation technique, and US$ 240 000 when screening donors tested before by this technique. MH - *Blood Donors ; Blood Transfusion/ADVERSE EFFECTS ; Comparative Study ; Cost Benefit Analysis ; Counterimmunoelectrophoresis ; Denmark ; Hepatitis B/ETIOLOGY/PREVENTION & CONTROL ; Hepatitis B Surface Antigens/ *ANALYSIS/IMMUNOLOGY ; Human ; Mass Screening/*ECONOMICS/METHODS ; Radioimmunoassay ; Support, Non-U.S. Gov't SO - Liver 1986 Jun;6(3):173-7 3 UI - 86291319 AU - van der Does JA ; van Antwerpen CE TI - Starting a plasmapheresis program with hollow-fiber filtration. AB - In a routine donor center, a program of hollow-fiber filtration can be instituted. With the Organon Teknika PLASMAPUR system the collection of 600 ml plasma was completed within 50 min in 76% of the procedures. Changing the tubing set took 12-15 min. From the plasma a frozen cryoprecipitate is made with a recovery of 59%. After pooling, lyophilization and heat treatment, the recovery is 42%. MH - Allied Health Personnel ; Blood Donors ; Costs and Cost Analysis ; Factor VIII/ISOLATION & PURIFICATION ; Human ; Netherlands ; Plasmapheresis/ ECONOMICS/*INSTRUMENTATION ; Time Factors SO - Vox Sang 1986;51 Suppl 1:45-8 4 UI - 86281895 AU - Snyder JA ; Smith AD TI - Staghorn calculi: percutaneous extraction versus anatrophic nephrolithotomy. AB - We compared the procedure time, success rates, complications and recovery times for percutaneous ultrasonic lithotripsy (75 cases) and anatrophic nephrolithotomy (25) in patients with staghorn stones. Although the frequency of retained stone fragments was higher in the former group (13.3 versus 0 per cent), the shorter total procedure time (average 155.1 versus 266.5 minutes), lesser need for blood transfusions (average 2 units packed red cells in 53 per cent of the patients versus 3.5 units in 70 per cent) and narcotics (average 16 versus 33 doses), and far more rapid return to work (average 14.3 versus 54.5 days after the patients were discharged from the hospital) strongly favor percutaneous over open stone removal. MH - Adult ; Analgesics, Addictive/THERAPEUTIC USE ; Blood Transfusion ; Comparative Study ; Costs and Cost Analysis ; Female ; Follow-Up Studies ; Human ; Kidney Calculi/SURGERY/*THERAPY ; *Lithotripsy ; Male ; Middle Age ; Nephrostomy, Percutaneous ; Pain, Postoperative/DRUG THERAPY ; Postoperative Complications/ETIOLOGY ; Time Factors SO - J Urol 1986 Aug;136(2):351-4 5 UI - 86266702 AU - Callaham M TI - Inaccuracy and expense of the leukocyte count in making urgent clinical decisions. AB - The care of 172 patients with abnormal white blood count (WBC) results was examined by chart review and physician interview. Neither the total leukocyte count, the neutrophil count, nor the band count reliably distinguished between bacterial, nonbacterial, and noninfectious disease. The positive predictive value for bacterial disease of a WBC greater than or equal to 12,500/mm3 was only 26%, with either a neutrophil count greater than or equal to 10,000/mm3 or a band count greater than or equal to 500/mm3, the positive predictive value was only 33%. Of WBCs, 21% were ordered by mistake when another (or no) test was desired. Only 18 abnormal WBCs of 172 (10.4%) (of the total 860 obtained) had any impact on the patient's clinical management, and only ten caused impact judged to be neutral or beneficial. Based on a WBC and differential costs of +23.50, obtaining an abnormal result that had a clearly beneficial impact on patient care would cost +10,105 in unneeded tests. The WBC does not in itself reliably predict severity or cause of disease in acutely ill adults, and its widespread use as a screening test in this setting probably should be abandoned. MH - Acute Disease ; Adult ; Bacterial Infections/DIAGNOSIS ; California ; Child ; Cost Benefit Analysis ; Diagnostic Tests, Routine/*ECONOMICS ; Emergency Service, Hospital/*ECONOMICS ; Human ; Infection/*DIAGNOSIS ; *Leukocyte Count ; Neutrophils ; Virus Diseases/DIAGNOSIS SO - Ann Emerg Med 1986 Jul;15(7):774-81 6 UI - 86266227 AU - Tawes RL JR ; Scribner RG ; Duval TB ; Beare JP ; Sydorak GR ; Rosenman JE ; Brown WH ; Harris EJ TI - The cell-saver and autologous transfusion: an underutilized resource in vascular surgery. AB - The vascular surgeon's best resource for blood transfusion is the patient's own blood. It is readily available for recycling, already precisely typed and crossmatched, and without the risk of transfusion-related diseases such as hepatitis and AIDS. The relative ease, safety, and cost-effectiveness of autologous blood transfusions, intraoperative autotransfusions, and postoperative autotransfusions has been shown in our hospital experience with 320 cases and in the literature. We predict that autologous donor blood and autotransfusion will soon be widely accepted and utilized as the best and safest method of blood replacement. MH - *Blood Transfusion, Autologous/ADVERSE EFFECTS/ECONOMICS/INSTRUMENTATION ; Cell Separation ; Cost Benefit Analysis ; Hemorrhage/ETIOLOGY ; Human ; Hypothermia/ETIOLOGY ; *Vascular Surgery SO - Am J Surg 1986 Jul;152(1):105-9 7 UI - 86254535 AU - Palmer RH ; Kane JG ; Churchill WH ; Goldman L ; Komaroff AL TI - Cost and quality in the use of blood bank services for normal deliveries, cesarean sections, and hysterectomies. AB - To reduce costs, preserve blood supplies, and enhance the safety of blood use during emergencies, the Department of Obstetrics and Gynecology and the blood bank at a teaching hospital recommended replacing pre-delivery crossmatch on selected patients with typing and screening for all patients undergoing normal or cesarean section delivery. Using an automated data system, it was shown that 75% and 50% reductions in the ordering of crossmatching for these two groups of patients promptly resulted, endured over a one-year follow-up period, and also spread to include patients undergoing hysterectomy. However, the cost of the increased use of typing and screening outweighed the reduced cost of crossmatching: actual annual costs increased by $11 151. We conclude that test-ordering practices can be changed surprisingly easily if a specific and reasonable policy is advocated by influential clinicians. However, changes in test use can cause unexpected cost increases. Only detailed study of practice patterns can reveal cost consequences for a specific institution. MH - Blood Grouping and Crossmatching/*METHODS ; Blood Transfusion/ECONOMICS/ *UTILIZATION ; Boston ; *Cesarean Section ; Cost Control ; *Delivery ; Erythrocytes/TRANSPLANTATION ; Female ; Hospital Bed Capacity, 500 and over ; Human ; *Hysterectomy ; Medical Audit ; Pregnancy ; Support, Non-U.S. Gov't SO - JAMA 1986 Jul 11;256(2):219-23 8 UI - 86227733 AU - Brown MW ; Carson CC 3d ; Dunnick NR ; Weinerth JL TI - Comparison of the costs and morbidity of percutaneous and open flank procedures. AB - A series of 47 percutaneous procedures for renal calculi was matched by description of calculi and previous flank exploration to 47 open flank procedures for comparison of relative morbidity and cost-efficiency. A retrospective analysis of paired data demonstrated that patients undergoing percutaneous procedures experienced significantly decreased duration of anesthesia, number of transfusions, postoperative disability, and duration and cost of hospitalization. These findings support the cost-effectiveness of the percutaneous approach to removal of renal calculi. MH - Adult ; Aged ; Blood Transfusion ; Comparative Study ; Cost Benefit Analysis ; Costs and Cost Analysis ; Fees, Medical ; Female ; Human ; Kidney Calculi/*THERAPY ; *Lithotripsy/ADVERSE EFFECTS/ECONOMICS ; Male ; Middle Age ; *Nephrostomy, Percutaneous/ADVERSE EFFECTS/ECONOMICS ; Postoperative Complications/*ETIOLOGY ; Retrospective Studies SO - J Urol 1986 Jun;135(6):1150-2 9 UI - 86209374 AU - Kline LM ; Friedman LI ; Severns ML TI - Cost analysis of routine laboratory testing in blood centers. AB - The direct costs of ABO, Rh, Du, syphilis, and antibody screening tests were investigated. Questionnaires from 58 blood centers were analyzed to compare cost-effectiveness among methods of testing and annual collection volume as well as differences in cost of the various methods of testing within the same-size center. We found that "expensive: automated equipment cannot be justified on the basis of direct costs in centers processing less than 100,000 units of blood per year and that there is a wide variation in costs among centers using the same equipment. MH - Blood Grouping and Crossmatching/*ECONOMICS ; Blood Transfusion/ *ECONOMICS ; Costs and Cost Analysis ; Human ; Isoantibodies/ANALYSIS ; Syphilis/DIAGNOSIS SO - Transfusion 1986 May-Jun;26(3):227-30 10 UI - 86160705 AU - Horn ME ; Dick MC ; Frost B ; Davis LR ; Bellingham AJ ; Stroud CE ; Studd JW TI - Neonatal screening for sickle cell diseases in Camberwell: results and recommendations of a two year pilot study. AB - The sickle cell diseases are a major health problem for Afro-Caribbean peoples. Neonatal detection and prophylactic management can reduce mortality and morbidity in childhood. A study was therefore conducted analysing the results of the first two years of cord blood screening in the Camberwell health area. Thirteen cases of sickle cell disease and two of haemoglobin (Hb)C disease were identified among 2202 non-white infants screened. The carrier state, sickle cell trait (HbAS), was present in 11.9% and HbC trait (HbAC) in 4.1% of Afro-Caribbean infants. The incidence of disease and of carrier states was much higher in West Africans than in Caribbeans. The wider implications of screening and the need for a comprehensive plan of care are emphasised. MH - Anemia, Sickle Cell/*OCCURRENCE ; Child, Preschool ; Costs and Cost Analysis ; Ethnic Groups ; Fetal Blood/ANALYSIS ; Hemoglobin SC Disease/ OCCURRENCE ; Human ; Infant ; Infant, Newborn ; London ; *Mass Screening/ ECONOMICS ; Pilot Projects ; Support, Non-U.S. Gov't SO - Br Med J [Clin Res] 1986 Mar 15;292(6522):737-40 11 UI - 86127272 AU - Gardner LI Jr ; Redfield RR ; Lednar WM ; Lemon SM ; Miller RN TI - Occupational and geographic risk factors for hepatitis B among US Army enlisted personnel during 1980. AB - Hepatitis B hospitalization rates for US Army enlisted personnel were determined by occupation and geographic area for 1980. The only group in the US Army currently recommended to receive hepatitis B vaccine is medical personnel regularly exposed to blood. Other groups of Army personnel, specifically those working in areas of high hepatitis B endemicity, have been thought to be at higher risk. Therefore, this work was undertaken to document hospitalization rates for all personnel using occupational blood exposure criteria as well as geographic area of assignment as risk factors for hepatitis B. The hospitalization rates underestimate true rates of hepatitis B incidence by a wide margin, and therefore were not used to calculate specific costs and specific benefits for a new vaccination strategy. In spite of this limitation, these data were useful for calculating relative risk, attributable risk, and amount of vaccine preventable disease. The risk of hospitalization for blood-exposed employees was consistently higher than that for non-blood-exposed personnel. The magnitude of the relative risk for blood exposure may be as high as 3.8 times or as low as 1.2 times, depending on which occupational comparison group is used. The relative risk of hospitalization in South Korea vs. the United States was 3.1 (p less than 0.0001), that for Europe vs. the United States, 2.1 (p less than 0.0001). Of all occupational and geographic risk comparisons, assignment to South Korea carried the highest attributable risk: 225 per 100,000. The amount of vaccine preventable disease in personnel assigned to South Korea was similar to that in occupationally blood-exposed employees (5.5 vs. 5.2 hospitalized cases per 1,000 vaccinees) after prorating exposure to risk based on average number of days of exposure to risk over three years. These data support the argument that geographic factors are as important as occupational blood exposure in defining risk of hepatitis B hospitalization among the US Army enlisted personnel. MH - Blood ; Costs and Cost Analysis ; Environmental Exposure ; Europe ; Geography ; Health Manpower ; Hepatitis B/*OCCURRENCE/PREVENTION & CONTROL/TRANSMISSION ; Hospitalization ; Human ; Korea ; *Military Personnel ; Occupational Diseases/*OCCURRENCE/PREVENTION & CONTROL/ TRANSMISSION ; Occupations ; Risk ; United States ; Vaccination/ECONOMICS ; Viral Hepatitis Vaccines SO - Am J Epidemiol 1986 Mar;123(3):464-72 12 UI - 86124042 AU - McFarland JG ; Larson EB ; Hillman RS ; Slichter SJ TI - Cost-benefit analysis of a plateletapheresis program. AB - We determined costs and benefits of a community donor plateletapheresis program (CDPP) designed to provide HLA-matched platelet transfusions for patients who were refractory to random-donor platelets (RDPs). Costs of establishing and maintaining the CDPP were $127,520 for the first year (1982). Benefits were expressed as cost savings attributed to the CDPP. After the program began, the use of RDP in the community was 17,458 units less than projected. Estimates of net cost savings during the first year ranged from $177,570 to $272,253 (1982 dollars; cost-to-benefit ratios were 1:1.39 to 1:2.14.) In a matched cohort study of marrow transplant patients, CDPP platelet transfusions were as effective as those from family donors while total platelet and red cell use was unchanged. In patients with acute leukemia treated with chemotherapy, significant reduction in both platelet and red cell use was seen after institution of CDPP support. We conclude that the CDPP is a cost-effective approach to platelet support. MH - Acute Disease ; Blood Component Removal/*ECONOMICS ; Blood Donors ; Blood Platelets/*TRANSPLANTATION ; Bone Marrow/TRANSPLANTATION ; Community Health Services/*ECONOMICS/UTILIZATION ; Comparative Study ; *Cost Benefit Analysis ; Health Promotion/ECONOMICS ; Histocompatibility Testing ; Human ; Leukemia/DRUG THERAPY/ECONOMICS/THERAPY ; Plateletpheresis/*ECONOMICS/UTILIZATION ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. SO - Transfusion 1986 Jan-Feb;26(1):91-7