Comparison between traditional and goal directed perfusion in cardiopulmonary by-pass. A differential cost analysis in US

Abstract

OBJECTIVES: High oxygen delivery (DO2) during cardiopulmonary bypass (CPB) is associated with better renal outcome in cardiac surgery. Traditional perfusion (TP) techniques, targeted on body surface area and CPB temperature, achieves high DO2 in about 50% of the cases while a goal directed perfusion (GDP) approach can lead to more than 90% of cases achieving high DO2 with a consequent reduction in Acute Kidney Injury (AKI) rate of about 40%. Aim of this study is to perform an economic evaluation of GDP strategy with respect to TP in US. METHODS: A Discrete Event Simulation model was developed to compare TP and GDP strategy in patients undergoing CPB. The patient’s pathways from operation to discharging from hospital was simulated: AKI incidence, in-hospital mortality, hospital length of stay, transfusions were correlated to probability to achieve high DO2 target using published correlations. National perspective was adopted to calculate costs associated to each event while GDP strategy was exploited the introduction of Sorin Heartlink (HL) Card/GDP Card and Sorin Connect (electronic data management system). RESULTS: GDP strategy saved more than 3 days in hospital and 11% of AKI episodes. The cost-saving is $ 3,137 (95% CI: 1,122-4,951); the cost of HL Card/GDP Card+Connect ($ 180, 95% CI: 113-249) is more than offset by savings in hospital stay that result the main driver in cost ($ 3,222, 95% CI: 1,235-4,950). Deterministic sensitivity analysis shows that the total savings are mainly influenced by nadir haematocrit during CPB and hospital LOS/cost per day both in ICU and in ward. CONCLUSIONS: GDP seems to improve significantly the main outcomes related to CPB surgery, when compared to TP techniques. Additional costs due to perform GDP strategy have no impact on the total cost since completely offset by the savings in hospital cost.