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Blood Inflation

Blood 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…. American (from Minnesota!)

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Blood Inflation

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  1. Blood Inflation Karen L. Dallas, M.D.C.M. TMR Journal Club May 4, 2010

  2. “Activity-Based Costs of Blood Transfusions in Surgical Patients at Four Hospitals”~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Transfusion April 2010. Vol 50(4), 753-765.

  3. About me… • American (from Minnesota!) • McGill Medical School • U of T – Hematopathology Residency • BloodCenter of Wisconsin Fellowship in Transfusion/Coagulation + Research • …then back to Canada! 

  4. Objectives • Why this article? • Relevant background information • Article Review • Critical Appraisal • Discussion (the “meat & potatoes” of this JC!)

  5. Why? (at least some 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

  6. Canadian 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

  7. Accounting 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 Costing VS. • Activity-Based Costing (ABC)

  8. Entire 136-page OCCI Guide… 0 entries for transfusion or blood!!

  9. Methods

  10. Main Processes in Transfusion Chain

  11. Flow Diagram (YIKES!)

  12. Formulas… (YIKES!)

  13. Costs of Acquisition and Costs per Unit

  14. 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…

  15. DiscussionA 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?

  16. Thank-you! • Dr. Skeate and • CBS Medical Office, Toronto • Dr. Fernandes, U of T Hematopathology

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