Activity‐based costs of blood transfusions in surgical patients at four hospitals

TLDR

Blood utilization has long been suspected to consume more health care resources than previously reported, and incomplete accounting for blood costs can misdirect programmatic decision making by health care systems. The study aims to determine the cost of blood transfusions in surgical patients using an activity‑based costing model and to investigate whether stricter blood utilization control can improve health care utilization, quality, and reduce costs. The authors prospectively identified tasks and resource consumption for blood administration at two US and two European hospitals, retrospectively captured process frequency data, and used these inputs to populate an activity‑based costing model. The activity‑based costing model estimated per‑RBC‑unit costs between $522 and $1183 (mean $761 ± $294), which are 3.2‑ to 4.8‑fold higher than acquisition costs, and annual expenditures per hospital ranged from $1.62 to $6.03 million, confirming that blood costs are underestimated, vary geographically, and present opportunities for cost containment.

Abstract

Blood utilization has long been suspected to consume more health care resources than previously reported. Incomplete accounting for blood costs has the potential to misdirect programmatic decision making by health care systems. Determining the cost of supplying patients with blood transfusions requires an in-depth examination of the complex array of activities surrounding the decision to transfuse.To accurately determine the cost of blood in a surgical population from a health system perspective, an activity-based costing (ABC) model was constructed. Tasks and resource consumption (materials, labor, third-party services, capital) related to blood administration were identified prospectively at two US and two European hospitals. Process frequency (i.e., usage) data were captured retrospectively from each hospital and used to populate the ABC model.All major process steps, staff, and consumables to provide red blood cell (RBC) transfusions to surgical patients, including usage frequencies, and direct and indirect overhead costs contributed to per-RBC-unit costs between $522 and $1183 (mean, $761 +/- $294). These exceed previously reported estimates and were 3.2- to 4.8-fold higher than blood product acquisition costs. Annual expenditures on blood and transfusion-related activities, limited to surgical patients, ranged from $1.62 to $6.03 million per hospital and were largely related to the transfusion rate.Applicable to various hospital practices, the ABC model confirms that blood costs have been underestimated and that they are geographically variable and identifies opportunities for cost containment. Studies to determine whether more stringent control of blood utilization improves health care utilization and quality, and further reduces costs, are warranted.