Quantra Q-plus Point of Care Coagulation Analysis Reduces Blood Product Cost Burden in Patients Undergoing Cardiac Surgery

Quantra Q-plus Point of Care Coagulation Analysis Reduces Blood Product Cost Burden in Patients Undergoing Cardiac Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Quantra Q-plus Point of Care Coagulation Analysis Reduces Blood Product Cost Burden in Patients Undergoing Cardiac Surgery Bruce D. Spiess, Melissa A. Burger, Yong G. Peng, Cynthia Garvan, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5926543/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background: Despite long standing blood management guidelines for cardiac surgery, VET is underutilized, and fewer institutions employ new real-time operating room-based POC-VET. We evaluated the cost effects of POC-VET coagulopathy management at a single institution when the technology was implemented. Hypothesis: The hypothesis was that POC-VET-guided reduction in blood transfusion, wastage, and pro-thrombotic pharmaceuticals generated cost savings. Methods: 596 patients were analyzed from a time prior to POC-VET coagulation management and 253 after implementing the Quantra Qplus system (Hemosonics LLC). Blood component and pharmaceutical costs were estimated from available literature to develop blood acquisition costs, two models of total hospital blood costs and pharmaceutical costs. All models were standardized to 500 patients. Results: Estimated direct acquisition costs of components were reduced by 16%, from $643,610 (Pre-PBM) to $540,500 (PBM-Quantra) per 500 patients. Estimated total hospital costs of transfusions were reduced between 17.5-18.3% (Model 1: $2,488,418 Pre-PBM vs. $2,053,900 PBM-Quantra; Model 2: $3,868,840 Pre-PBM vs. $3,159,525 PBM-Quantra). Estimated direct costs for blood component wastage were reduced by 86.2% ($175,000 PRE-PBM vs $24,195 PBM-Quantra per 500 patients). Estimated total costs for blood product were reduced by 86.2-85.8% (Model 1: $665,076 Pre-PBM vs. $91,941 PBM-Quantra; Model 2: $1,031,157 Pre-PBM Quantra vs $146,687 PBM-Quantra, all per 500 patients.) Pharmaceutical costs were reduced from $226,353 to $162,740 per 500 patients. Overall combined amortize savings per patient were between $635 to $3,315. Conclusions : This study showed that adoption of the Quantra Qplus POC-VET resulted in significant cost savings of unnecessary transfusions, less ordering of coagulation components and pro-coagulant pharmaceuticals. Cost containment and effective allocation of limited resources such as blood component is paramount to PBM. Cardiac surgery Transfusion Cost Patient Blood Management Transfusion Coagulation Sonorheometry Quantra Point of Care Introduction Transfusion remains variable in cardiac surgery. 1 , 2 Patient blood management (PBM) has reduced blood utilization, yet transfusion behavior remains institution and physician dependent. 1 – 7 PBM guidelines are adopted in less than 50% of centers. 8 , 9 Approximately 15–30% of cardiac patients experience excessive bleeding. 13 , 14 Major (≥ 5 units of PRBCs) and massive (≥ 10 units of PRBCs) bleeds account for 40% of PRBCs transfused. 13 , 14 Abnormal cardiac bleeding has been defined. 14 , 15 Adverse outcomes associated with PRBCs are focused upon, with coagulation component risks less well appreciated. 4 , 10 , 11 , 12 PRBCs have a 13–16% /unit increase in mortality and immunosuppression, myocardial infarction, pneumonia, lung dysfunction TRALI, volume overload (Transfusion Related Acute Cardiac Overload–TACO), heart failure, renal dysfunction/failure, iron overload, prolonged intensive care unit (ICU) and hospital length of stay. 3 Fresh frozen plasma (FFP) and platelet concentrates (PC) have 10 and 6%/unit respective increased mortality as well as more TRALI and pneumonia than PRBCs. 3 , 19 The risks of FFP, PC and cryoprecipitate (Cryo) are further reported. 5 , 10 , 11 , 12 , 16 , 17 Without coagulation data, PCs are associated with increased mortality, stroke, and transfusion related acute lung injury (TRALI), 10 , 12 yet in one meta-analysis PC usage experienced improved outcomes when bleeding was treated. 11 Coagulation components are expensive and scarce (PC). Major and massive bleeding, causes further microvascular bleeding. 16 , 17 When unguided therapy (“clinical judgement”) is invoked, the use of FFP leads to more PRBCs infused than if saline alone was utilized. 16 , 17 FFP is less effective than PC or prothrombin complex concentrate (PCC) in bleeding. 16 , 17 , 18 Guidelines mandate data driven management. Monitoring coagulation is a PBM quality outcome variable to reduce adverse events, mortality and costs. 1 – 18 Bleeding begets more bleeding. The use of coagulation components to prevent bleeding (prophylaxis) is contraindicated. The Cochrane Collaborative notes VET decreases blood transfusion, improves outcome and cuts costs. 19 The Quantra QPlus (HemoSonics, LLC, Triangle Park, NC) is an ultrasound-based, near real-time, cartridge-based, rapid, in-operating-room diagnostic platform. 20 – 24 The coagulation parameters measured by Quantra correlate with other VET and central laboratory coagulation assays (CLCA). 20 – 24 Quantra’s rapid assessment of intraoperative coagulopathy reduces blood product transfusion and waste. 21 – 26 Cost savings have yet to be quantified. Data from the accompanying article was leveraged to costs. Methods Study Design and Data Source The Burger et al. article is a single-center, retrospective, observational, cohort study, that quantified differences in blood component utilization, over ordering, discarded and returned to the blood bank-BB, but it did not examine costs. That study was deemed, retrospective an exempt study by the University of Florida (UFl) Institutional Review Board (IRB) (IRB 202002288 and IRB 202000163). Data were extracted from the electronic medical record (EMR) Epic (Epic Systems Corporation, Madison, WI) and UFl-Society of Thoracic Surgeons (STS) database. Patient Cohort Briefly, 253 consecutive adults undergoing elective or urgent cardiothoracic surgery who were managed with the Quantra Qplus system over a six-month period (2022 PBM-Quantra group) were compared to a cohort of 596 Pre-PBM (2019 pre-COVID-19) historical controls. Pre-PBM patients were managed with “clinical judgement”, CLCA testing and/or laboratory-based TEG 5000 (TEG, Haemonetics Inc, Braintree, Massachusetts, USA). The PBM-Quantra group of patients had a coagulopathy treatment algorithm available as a decision aid. The number of units utilized Pre-PBM and PBM-Quantra for each product and pharmaceutical was divided by the number of patients (596 and 253) yielding a mean per patient, then computed per 500 patients. Primary Outcome The primary outcome compared cost of blood between the two groups. The acquisition and total hospital (models 1 and 2) cost burdens were calculated in aggregate and for 500 patients. 27-29 Secondary outcomes The costs of excess ordering (PRBCs, PC, FFP and Cryo from BB) returned or wasted (100% Cryo not infused is wasted) was computed per patient and for 500 patients. Although PRBCs and FFP can be returned to the BB, PC off the shaker for 4 hours may be discarded. There was no way of tracking which units returned to the BB were reutilized, versus discarded. All units brought to the OR were computed into the excess ordering costs (an overestimate). The hospital could recoup some revenue from PRBCs and FFP, but we do not know how much. BB incurred costs in inventory restocking, tracking, storage, re-cross match, and these have not been cost modeled. The average cost per unit of each product was calculated (Table 1), then multiplied by the total number of units. The difference in cost between the two groups was identified as the total reduction in unutilized or wasted products. Blood Product Cost Calculation PRBCs Costs were reported for acquisition (direct) and two models of total hospital cost (indirect), obtained from multiple sources (Table 1). The American Association of Blood Bankers (AABB) reports to Congress via Health and Human Services (HHS) yearly with a chart of acquisition cost of PRBCs. 24 The 2019 report was utilized for this manuscript. 24 We could not access more recent reports. In 2019 Q2, $248.00/unit was PRBC acquisition cost. An academic source from 2011 listed PRBCs acquisition at $211.00/unit. 29. The cost of PRBCs at Johns Hopkins University in 2017 was $220.00/unit. 30 These data as well as a reported range 25,29 created a best PRBC cost estimate (Table 1). That estimate was made by interpolating the average annual blood inflation rate (2.5%/annum over the last 20 years not compounded) 31 to calculate increases from 2011 27 or 2019 (AABB/HHS data). Translating the 2011 data of $211.00 to a 2024 estimate, yielded $279.00. Using HHS 2019 data PRBCs interpolated for inflation, the 2024 cost was the same- $279.00. For the remainder of the manuscript, we rounded to $275.00, perhaps more of a 2022 estimate. Some will think the number high, and others low, it is at best our estimate. FFP, PC and Cryo Less information is available for the average costs of FFP, PC and Cryo. Using the same 2.5% inflation rate, FFP cost was assigned $75.00/unit (2011 - $60.70) and PC at $635.00 (2011 -$534.00). 29 The HHS report is vague on coagulation product costs. A hospital in Cleveland noted platelets at $1000.00/unit in 2013. 32 Cryo had one estimate at $350.00. 33 Precise acquisition costs are less important than decreases as blood utilization from Pre-PBM to PBM-Quantra periods. Total dollar reductions could be different if initial costs but percentage changes would be constant. Total hospital costs are higher than acquisition. 27-38 They include supply management, type and cross-matching, issuing, transport, delivery, clerical/technician time, monitoring/management of adverse outcomes, BB outdating (not OR wastage), OR personnel time for transfusion, infusion IV, fluids, filters, OR and ICU clerical time. 27-38. Estimates of total hospital costs range from 3.2 to 4.4-fold as multipliers of acquisition. 27-38 Model 1 utilized a multiplier of acquisition, set at 3.8 times (mid-range) purchase price. Model 2 utilized actual highest reported data published on total hospital costs. 27-38 The PC cost in model 2 was dramatically larger than model 1. 38 PC treatment may be ineffective due to infusion of un-crossmatched PC. 38 Therefore more units of PC may be required to achieve a goal 38 We suspect, in cardiac surgery un-crossmatched PC is the practice. Teams do not have a defined goal or do not test whether PC reached the goal effective (target platelet count, or POC-VET platelet activity achieved). Most likely clinicians only note whether bleeding has decreased. A range for PC cost between $3373.00-$4476.00 for a single treatment is reported. 38 If PC refractoriness is combined with side effects (adverse events), estimates rise upwards of $5258.00 to $13,117.00 in non- cardiac surgery. 38 No PC effectiveness or refractoriness data in cardiac surgery exist. 10 For model 2 analysis in this study PC costs were set at $4281.00, a mid-range . 38 Acquisition, and total hospital costs (models 1 and 2) together provide cost comprehensive understanding. No cost estimates of the burdens of adverse events ascribed to transfusion were calculated. Estimating cost reductions in total medical care due to reduced adverse events is speculative at best and hard to judge in 500 patients. Pharmaceutical Costs Pharmaceutical agents to enhance clot formation include prothrombin complex concentrate 4 factor (PCC), Factor VIIa (VIIA) desmopressin acetate (DDAVP) and fibrinogen concentrate (FIB). Costs of drugs are negotiated between individual hospitals and pharmaceutical supply houses. Table 4 contains costs supported by published data or available on the internet as costs for each drug. 37, 39-43,47 A “full” dose for VIIa of 90ug/kg at a cost of $0.85-$1.30/ug (we chose 1.00/ug) and 80 kg (UFl patients are not usually70kg) was estimated at $6300.00. 39,40,47 Lower doses may have efficacy but when refractory bleeding was encountered in the pre-PBM period a maximum dose was given. For Fib the cost depends upon the dose, about $1.00 per mg. Table 4 showed a 1 gm dose but often 2-3 gm or more are infused. 42,43 PCC cost was calculated at a dose of 25ug/kg (factor IX level) for an 80 kg person. Published costs varied between $2300.00 to above $4000.00 for warfarin reversal. 33,43 DDAVP costs are highly variable, and efficacy is unproven, 40ug in 10 ml is $168.00. However, that may not be effective, thus our estimate is $250.00. 41 Statistical Analysis Statistical analyses were performed using R version 4.2.1. SAS for the Berger manuscript. Descriptive statistics were reported as frequencies with percentages for categorical variables and as means with standard deviations or medians with 25th and 75th percentiles for continuous variables, as necessary. Between groups, categorical variables were compared using chi-squared test or Fisher’s exact test and continuous variables compared using Mann-Whitney U tests. Periprocedural characteristics among pre-PBM patients versus PBM-Quantra usage were compared; variables showing p-value less than 0.05 were determined as significant. Due to the retrospective nature of the study, imbalance in the distribution of confounders was addressed using standardized differences. The cost differences were not tested for statistical significance since dollars differences are self-evident and not in need of statistical analysis. Although differences, for example in per case usage of PRBCs did not reach statistical significance in the population, usage of any particular blood component translated to a cost differences reported here. We leave it to the reader to judge what level of cost differential is meaningful. Handling of missing or invalid data The primary and secondary outcome variables may have had missing blood records. If blood unit numbers were not recorded in the (EMR) it was assumed, they were unutilized. Errors in scanning unit numbers into the EMR may have occurred, but that was assumed to be the same in both groups. If unutilized PRBCs were brought back to the BB and utilized as a reassigned resource, what is the true cost to the hospital? Some might assume the entire cost was recouped. Units out of inventory for 6-8 hours must create a cost. Clerical time was required to check them out and back into inventory. Any reassignment of a unit would have to go through type, cross, and clerical work all over again (doubling total hospital costs). This is a source of error for the unutilized cost estimates. However, no accurate estimates of such costs exist. If RBC units are returned to BB the only cost recouped is acquisition, the least cost of all. Results Reduction in Blood Product Usage The PBM-Quantra patients demonstrated reduced blood usage (Tables 2-5). PRBCs decreased from 1.22 units to 0.92 units/pt. FFP fell from an already low level (0.21 units/pt) to non-existent (0.01 units/pt). PC infusions were unchanged while Cryo was reduced from 0.70 to 0.64 units/pt. The acquisition and total hospital (two models) cost changes are shown in Table 2. Blood costs were substantial for 500 patients. Acquisition of PRBCs was $224,785.00 Pre-PBM reduced by 44% to $126,500.00 with PBM-Quantra utilization (Table 2). A 95% reduction in FFP translated into acquisition costs dropping from $7875.00 to $375.00. To a hospital, this may not seem to be a great deal of money, but FFP was rarely utilized Pre-PBM. Total hospital cost reductions created larger total potential savings (Table 2,3,4), but overall 44% percent reduction. Decreases in transfusion provided fewer savings than the change in physician ordering (Table 3). The savings due to changed ordering was 1.24-to-1.46-fold that for transfusion (Table 2,3,5). The savings by changed ordering practices of coagulation components are 72.3% for acquisition alone, model 1, 72.3% and model 2, 70.3% (Table 3,5) Pharmaceuticals (Table 4, 5), decreased 55% in expenditures driven largely by VIIa reductions. The computation of ordered to unutilized ratio (O/U) is different than crossmatch to transfusion ratio (C/T) (Table 3). The Pre-PBM C/T ratio for PRBCs was 2.54 and PBM-Quantra dropped to 1.6. The O/U ratio per patient for PRBCs was 2.07 Pre-PBM and 0.54 in the PBM-Quantra (P < .0001). Expressed differently, physicians ordered 60% more PRBCs than they utilized pre-PBM and only 35% more than they infused in PBM-Quantra. For FFP, the O/U was 1.17 units/pt. Pre-PBM and 0.02 PBM-Quantra (P < .0001). We did not compute C/T ratios for coagulation components that not crossmatched. O/U serves to depict physician behavior. For PC the O/U was 0.29 units Pre-PBM and 0.05 in the PBM- Quantra (P < .0001). Lastly, the Cryo O/U was 0.22 in the Pre-PBM period and 0.04 in PBM- Quantra (P < .0001). The use of pharmaceutical pro-thrombotic agents created savings (Table 4). Factor VIIa was eliminated. The use of FIB grew in lieu of Cryo. Overall, pharmaceutical costs were reduced by $130,012.00. Table 5 shows savings broken down into the sub-headings. Discussion Blood transfusion is variable between institutions and practitioners. 1-2 PBM guidelines in place since 2007 are under adopted. 8,9 Level 1 evidence for over 17 years, has supported the use of POC-VET. 8-9 Our data demonstrate reductions in ordering, utilization, and pro-coagulant pharmaceuticals. Once a PBM program utilizing the Quantra Qplus POC-VET analyzer was a part of everyday practice savings were many. Overall cost reductions ranged from $317,547.00 to $1,657,397.00 in 500 patients. That translates to $635.00 to $3315.00/pt. The lower number accounts for blood acquisition plus pharmaceuticals, whereas the highest number encompasses (model #2) total hospital costs overordering of blood plus the pharmaceutical costs. The total hospital costs, that we calculated in our tables, had two different models. Model number 1 multiplied hospital acquisition by a constant (3.8). People reading can ascribe the factor they wish for their acquisition to total hospital costs. However, acquisition costs account for less than a third of total hospital costs. Total hospital costs models are real, yet incomplete. The use of PRBCs in cardiac surgery is associated with a 13-16% increase in mortality per unit of blood. 3 What is the cost of mortality? FFP and PC have 10% and 6% mortality increase/unit. 3 Adverse events associated with transfusion include prolonged hospital stay, early readmission, prolonged ICU stay, renal dysfunction/failure, immunosuppression, increased hospital acquired infection, myocardial infarction, TRALI, TACO, bleeding and others. Each has associated costs, and many are not rare. In successful PBM programs cost reductions are large, both because of reduced hospital stays and lowered adverse event costs but also because of fewer blood components used. 27,44,45 Province (Ontario, Canada) and statewide (Western Australia) efforts noted reductions of total health care costs between 37 (Ca) and 100 (Aus) million dollars annually. 43,44 Neither included POC-VET for containment of coagulation blood product usage, wastage or change in physician behavior. More savings can be created. Our data did not estimate cost reductions if adverse events were decreased. 27,44,45 Much larger series or prospective trials are necessary to define adverse event reductions. However, our data speak for themselves without becoming speculative on adverse event costs. By reducing utilization approximately 44% of acquisition and total hospital blood costs were saved. Approximately 20-25% of blood collected is utilized in cardiac surgery. Reducing use alleviates shortages. There must be secondary macro-economic health care cost reductions when shortages are alleviated. One example of indirect costs incurred when shortages occur is that elective surgeries may be postponed creating far reaching, personal patient and family inconvenience, social and employment implications as well as hospital and medical care costs. Hemorrhage after cardiac surgery occurs in 6-15% of cases with variable frequency of return to OR for bleeding (1.5-7%). 42,46 Hemorrhage is associated with prolonged hospital stay and many adverse events. 42,46 Estimated costs for excessive bleeding are not inclusive of blood product costs have been reported. 46 In 2006 the additional incremental cost for hemorrhage was E6251.00 Euros or $33,338.00 (Australian dollars) without including blood product or return to OR costs. 42, 46 Monitoring technology that rapidly identifies the causes of bleeding, reducing excessive bleeding, should have far reaching cost reductions beyond just the blood costs we investigated. Blood components billed are not always reimbursed. Often, blood is part of bundled payments for a specific surgical procedure (CABG for example). In other cases, the first 3 units of blood are not reimbursed. A single transfusion charge per day is often all that is paid, thus not reimbursing for individual units infused. Blood costs may be a cost center, non-recoverable expenses in cardiac surgery. By invoking a plan of PBM with a POC-VET, UFl dramatically reduced its costs for blood and expensive pharmaceuticals. The changes in physician behavior by reducing over ordering had the greatest cost reduction. To stock a “cooler” with cold packs, check the blood out of the BB, do clerical documentation, have them checked in to the OR, crosschecked by nursing and anesthesiology all requires personnel time. That work product has never been cost modeled. When blood is returned to the BB clerical time is required. The fact that extra units were sent and not utilized meant that those units were out of inventory for 6-8 hours. If the BB maintains a given inventory, then checking those units out of inventory mandated the hospital purchasing more per year to maintain a stable inventory. That should be modeled. At UFl 3-4 cardiac ORs work per day with 1-3 cases per OR. For the sake of example only (not included in our reported cost data), if each OR ordered 4 units PRBCs (which was commonly done in 2019) and held them for 6-8 hours that would mean 12-16 units (assuming only 1 case per OR) would be outside the BB. Pre-PBM, 1.24 PRBC units/case were utilized meaning that 2.76 were returned to the BB. Assuming (conservatively) 10 units per day out of inventory, unutilized, for 250 (number of working days per year) an extra 2500 PRBC units would need to be ordered to maintain a stable inventory. When that level of extra ordering is multiplied by acquisition cost ($275) the added BB cost for maintenance of inventory is $687,500. If the blood is out of inventory for only 33% of time, one cannot imply that only 33% of the inventory maintenance cost is required. Somehow the BB has become accustomed to the over ordering and probably does not focus on this added cost created by physician behavior. That is the amount of money that the BB would have to expend to simply support the habit of the cardiac surgical team to have PRBCs sequestered in coolers in their ORs, for their convenience. With most of those units being unutilized that cost level, unreimbursed to the hospital, should be of interest for administrators. That was not included in our tables. The point is that units unutilized create hidden costs. Even with the best system, some that are sent to the OR do outdate. PRBCs are lost due to coolers not being returned when a case is concluded. Furthermore, the outdating of PC and Cryo represents true wastage. BB reports show that about 2-3% of blood outdates within the BB. BB does not report what is wasted outside of their control. Transfusion committees may follow such numbers. We cannot find a national average of this for cardiac centers. The crossmatch to transfusion ratio (C/T) is a measure of appropriateness of ordering used to benchmark surgical ordering. Best practices of C/T ratio show that the top 10% of hospitals have a C/T ratio of <1.5, 1:1 is ideal, and below 2 is a goal. 48 Pre-PBM the C/T ratio in this data was 2.54 and with PBM-Quantra the C/T ratio became 1.60. How can coagulation technology change the C/T ratio for PRBCs? The answer probably lies in an overall focus on PBM by a team that has learned the value of appropriate conservation of a scarce and costly resource. The ordered to unutilized (O/U) ratio decrease was dramatic, (74% reduction). These data show a reduction in anticipatory (“clinical judgement”) behavior. That change saved more money than the reduction in either overall blood usage or expensive medications. The public might react by knowing that their altruistically donated blood components were wasted. The United States experiences predictable and unpredictable blood shortages. The COVID-19 pandemic created a widespread, predicted, and preventable blood shortage. 46 Calls for adoption of PBM standards went unheeded in the United States. 2 Not only can a PBM program with POC-VET reduce utilization, but changed physician behavior created less unnecessary ordering, wastage and pharmaceutical costs. These behavior changes are direct dollar gains for the hospital. PBM programs have shown cost savings, being approximately 20-40% return on investments in the first year, with overall reductions in morbidity and mortality. 2,43,44 In both Ontario, Canada and Western Australia the institution of PBM programs reduced health care costs, length of stay, mortality, and many morbidities. 43,44 The use of PBM-Quantra is a potential triple or greater win: saving money, reducing adverse events, good for public health (decreasing adverse events and reducing blood shortages) as well as the individual patients. The cost of implementing a PBM program is known. 2,43,44 PBM involves coordinated education, data acquisition/analysis, anemia therapy, intraoperative red cell salvage, reduction of bleeding and coagulation therapeutic POC-VET individualized decision making. Practitioners wish to do the right thing when they are informed and given the tools. The tools for POC-VET are not expensive. Utilizing three test cartridges per case, the cost is estimated to be approximately $250.00-$300.00/case. Amortized for 500 patients that amounts to a $125,000.00-$150.000.00 cost for running tests. Paying $150,000.00 to save $317,547.00 to $1,657,397.00 makes sense. Limitations UFl is a large tertiary care center with residents, fellows and a very complex cardiac case mix. Because of the teaching nature of the medical center, cases may take longer than at private centers. Bleeding is surgeon, team and institution dependent as well as based upon the risk presented by the case mix. UFl is a regional complex aortic surgery center, that does fewer heart transplantations or device implantations than other centers. Protocols for heparin, protamine, and antifibrinolytics utilized here might differ as well as there was little FFP utilized prior to PBM-Quantra with none afterwards. Cardiac hospitals that infuse considerable FFP may encounter more cost savings other series with Quantra have noted the abolition of FFP. 20,21,22 At UFl use of FIB and PCC were evolving during the study period. The data reported represents a snapshot in time from one center. One may not be able to generalize the cost savings to other centers. We did not mandate nor police the use of the algorithm. A different study would need to be done to see if close adherence to an algorithm or the “best” algorithm could further enhance savings. Conclusion The institution of a PBM, POC-VET system in cardiac surgery was cost effective. It decreased costs for blood (acquisition and total hospital costs), unutilized blood and pharmaceuticals. With a minimum cost saving of $ 635.00/case and an upper savings of $ 3,315.00/case the institution of a POC-VET program is of value to hospitals doing heart surgery. Blood is a cost center. The savings created ought to be direct gains to the institution. If published adverse event rate reductions from PBM programs were to hold true with this intervention the cost saving just reported would be magnified. Prior to the institution of real time Quantra, POC-VET individualized coagulation decision making was not possible. PBM stresses individualized medicine. Today not only is coagulopathy able to be rapidly diagnosed and appropriately treated but it is capable of being handled in a highly cost-effective way that will improve hospital bottom lines, reduce blood costs, relieve blood shortages, decrease health care waste, individualize care, be good for the patient and be good for public health. Abbreviations AABB - American Association of Blood Bankers Aus - Australia BB - Blood Bank Ca - Canada C/T- Crossmatch to transfusion ratio CLCA - Central laboratory coagulation assays Cryo - Cryoprecipitate DDAVP - D-8-arginine vasopressin EMR - Electronic medical record VIIa - Factor VIIa FFP - Fresh frozen plasma FIB - Fibrinogen Concentrate HHS - Health and Human Services ICU - Intensive care unit IRB - Institutional review board NC - North Carolina OR - Operating room Pt - Patient PBM - Patient blood management PC - Platelet concentrate PCC - Prothrombin complex concentrate (4 factor) POC - Point of care Q-plus- Quantra Q-plus system QALY - Quality Added Life Year SAS - Statistical Analysis System STS - Society of Thoracic Surgeons TACO - Transfusion associated cardiac overload TRALI - Transfusion related acute lung injury US - United States UFl - The University of Florida VET - Visco-elastic technology PRBCs - Packed red blood cells Declarations Competing Interests Bruce D. Spiess, has disclosed he is medical director of HemoSonics LLC. He was not affiliated when the data was collected. Funding sources: none, in-house funded Author Contribution A: Conceived and designed the analysis: BS, CG, MB, YP,GAB: Collected Data: MB, YP, GAC: Performed the analysis: CG, MB, BSD: Wrote the paper: MB, BDS, YP, CG, LL, RK Data Availability Data is on file at University of Florida and in the STS database at Universiyt of Florida References Robich MP, Koch CG, Johnston DR, et al. Trends in blood utilization in United States cardiac surgical patients. Transfusion 2015;55(4):805-814. Hofmann A, Shande A, Blumberg N, Hamdorf J, Isbister JP, Gross I. Patient blood management: Improving outcomes for millions while saving billions. What is holding it up? Anesth Analg 2022;135: 511-523. Doi: 10.1213/ANE.00000000000006138. Choi UE, Nicholson RC, Frank SM, et. al. 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Desborough M, Sandu R, Brunskill SJ, et.al. Fresh frozen plasma for cardiovascular surgery. Cochrane Database Syst Rev . 2015; 14: CD007614. Doi 10.1002/14651858.CD007614.pub 2. Hinton JV, Fletcher CM, Perry LA, et al. Platelet versus fresh frozen plasma transfusion for coagulopathy in cardiac surgery patients. PLoS One 2024;19: e0296726. Doi 10.1371/journal. Pone 0296726.ecollection.2024. Hayes K, Fernando MC, Jordan V, Prothrombin complex concentrate in cardiac surgery for the treatment of coagulopathic bleeding. Cochrane Database System Rev 2022:11: CD013551.doi 10. 1002/14651858.cdc013551.pub2. Ad N, Massimiano PS, Rongione AJ, et. al. Number and type of blood products are negatively associated with outcomes after cardiac surgery. Ann Thorac Surg 2022; 113: 748-56. Doi.10.1016/j.athoracsurg.2021.06.061. Wetterslev WA, Møller AM, Afshari A. Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding (Review) Cochrane Library, Cochrane Database of Systematic Reviews . 2016; 8: CD007871. Doi: 10.1002/14651858.CD0007871.pub 3. Sniecinski RM, Tanaka KA. SEER Sonorheometry: Listening to What the Clot Has to Say. Anesth Analg . 2016;123(6):1346-1347. https://doi.org/10.1213/ANE.0000000000001587 Groves DS, Welsby IJ, Naik BI, et al. Multicenter Evaluation of the Quantra QPlus System in Adult Patients Undergoing Major Surgical Procedures. Anesth Analg . 2020;130(4):899-909. https://doi.org/10.1213/ANE.0000000000004659 DeAnda A, Levy G, Kinsky M, et al. Comparison of the Quantra QPlus System With Thromboelastography in Cardiac Surgery. J Cardiothorac Vasc Anesth . 2021;35(4):1030-1036. https://doi.org/10.1053/j.jvca.2020.11.058 Zlotnik D, Abdallah,GA, Lang E, et.al. Assessment of Quantra-guided hemostatic algorithm in high-bleeding-high-risk cardiac surgery. J Cardiothorac Vasc Anesth 2023;37: 724-731. Tibi P, Thompson J, Attaran S, Black E. Retrospective study assessing outcomes in cardiac surgery after implementation of Quantra. J Cardiothorac Surg . 2023;18(1):149. Rouissaux A, Halchini C, Ducrocq N, Bigeon J-Y, Lorne E . Retrospective Evaluation Of Economy In Blood Products Transfusion For Cardiac Surgery Patients Thanks To A Point-of-care Viscoelastic Test . Abstract A4023 . Presented at the Anesthesiology Annual Meeting. October 9, 2021. Virtual . http://www .as abstracts .com/strands/ asaabstracts/abstract .htm?year=2021&index=4&absnum=6350 Baulig W, Akbas S, Schűtt PK, et.al. Comparison of the resonance sonorheometry based Quantra® system with rotational thromboelastometry ROTEM® sigma in cardiac surgery--a prospective observational study. BMC Anesthesiology 2021; 21 (1) 260. Sapiano MRP, Jones JM, Savinkina AA, Haass KA, Berger JJ, Basavaraju SV. Supplemental findings of the 2017 National Blood Collection and Utilization Survey. Transfusion . 2020 Mar;60 Suppl 2(Suppl 2):S17-S37. doi: 10.1111/trf.15715. PMID: 32134122; PMCID: PMC7885895. Shander A, Hofmann A, Ozawa S, Theusinger OM, Gombotz H, Spahn DR. Activity-based costs of blood transfusions in surgical patients at four hospitals. Transfusion . 2010 Apr;50(4):753-65. doi: 10.1111/j.1537-2995.2009.02518. x. Epub 2009 Dec 9. PMID: 20003061 Toner RW, Pizzi L, Leas B, et. al. Costs to hospitals of acquiring and processing blood in the US: A survey of hospital-based blood banks and transfusion services. Appl Health Econ Health Policy 2011; 9:29-37. Doi: 1175-56652/11/0001-0029/$49,95/0. Hicks CW, Yang WW, DiBrito SA, et.al. A comprehensive Choosing Wisely quality initiative reduces unnecessary transfusions in an Academic Department of Surgery. American J Surg 2017;214: 571-576 doi: 10.1016/j.amjsurg.2017.06.020. https://fred.stlouisfed.org/series/PCU62199162199113 accessed August 28, 2024. Barnett CL, Mladsi D, Vredenburg M, Aggarwal K. Cost estimate of platelet transfusion in the United States for patients with chronic liver disease and associated thrombocytopenia undergoing elective procedures. J Med Econ . 2018 Aug;21(8):827-834. doi: 10.1080/13696998.2018.1490301. Epub 2018 Jul 2. PMID: 29912593. Abrahamyan L, Tomlinson G, Callum J, Carcone S, Grewal D, Bartoszko J, Krahn M, Karkouti K. Cost-effectiveness of Fibrinogen Concentrate vs Cryoprecipitate for Treating Acquired Hypofibrinogenemia in Bleeding Adult Cardiac Surgical Patients. JAMA Surg . 2023 Mar 1;158(3):245-253. doi: 10.1001/jamasurg.2022.6818. PMID: 36598773; PMCID: PMC9857805. Shander A, Ozawa S, Hofmann A. Activity-based costs of plasma transfusions in medical and surgical inpatients at a US hospital. Vox Sang . 2016 Jul;111(1):55-61. doi: 10.1111/vox.12386. Epub 2016 Feb 25. PMID: 26919686. Hofmann A, Ozawa S, Shander A. Activity-based cost of platelet transfusion in medical and surgical inpatients at a US hospital. Vox Sang 2021;116(9): 998-1004. Doi.10.1111/vox13095. Epub 2021 Mar 27/800-3350. Blumberg N, Asante AA, Nguyen PLT, Heal JM. Platelet transfusions: The good the bad and the ugly. Anesth Analg 2024; 138: 921-924. Doi: 10.1213. 0000000000006918. Barnett CL, Mladsi D, Vredenburg M, Aggarwal K. Cost estimate of platelet transfusion in the United States for patients with chronic liver disease and associated thrombocytopenia undergoing elective procedures. Journal of Medical Economics 2018; 21: 827-834. Doi: 10.1080/13696998.2018.1490301 Okerberg CK, Williams III LA, Kilgore CH, et.al. Cryoprecipitate AHF v. fibrinogen concentrates for fibrinogen replacement in acquired bleeding patients--an economic evaluation. Vox Sang 2016; 111: 292-298. Doi: 10.1111/vox.12417.Epub 2016 Jun 1. Kissela BM, Eckman MH. Cost effectiveness of recombinant factor VIIa for treatment of intracerebral hemorrhage. BMC Neurology 2008; 8:17, 1-9. Doi 10.1186/1471-2377-8-17. Kerr M. Protocol for factor VIIa reduces costs, increases off-label use. February 21,2002 Society of Critical Care Medicine. Viewed 9/2/2024. HTTP//Medscape.com/view article/552546? Form=fpf. Wang C, Lebedeva V, Yang J. et al. Desmopressin to reduce periprocedural bleeding and transfusion: a systematic review and meta-analysis. BMC Perioperative Med . 2024;5: 13. Doi 10.1186/s13741-023-00358-4. https://www.google.com/search?q=ddavp+cardiac+surgery+cost+cardiac&sca_esv=197713b87bf2beb1&sca Tanaka KA, Mazzefi MA, Strauss ER, Szlam F, Guzzetta NA. Computational simulation and comparison of prothrombin complex concentrate dosing schemes for warfarin reversal in cardiac surgery. J Anesth 2016; 30: 369-376 DOI 10.1007/s00540-015-2128-3. Christensen MC, Krapf S, Kempel A, von Heymann C. Costs of excessive postoperative hemorrhage in cardiac surgery. J Thorac Cardiovasc Surg . 2009;338(3):687-693. Pavenski K, Howell A, Mazer D, et. al. ONTraC: A 20-year history of a successfully coordinated provincewide patient blood management program: Lessons learned and goals Achieved. Anesth Analg 2022;135: 448-458. Doi; 10.1213/ANE.0000000000006065. Leahy MF, Hofmann A, Towler S, et.al. Improved outcomes and reduced costs with a health-system-wide patient blood management program: A retrospective observational management program: A retrospective observational study in four major adult tertiary -care hospitals. Transfusion 2017; 57: 1347-1358. Doi: 10.1111/trf.14006 Shander A, Goobie SM, Warner MA, et.al. Essential role of patient blood management oin a pandemic: A call to action. Anesth Analg 2020;51: 74-85. Doi: 10.1213. ANE00000000000000004844. Newcomb AE, Dignan R, McEldusff P, Pearse EJ, Bannon P. Bleeding after cardiac surgery is associated with an increase in the total cost of the hospital stay. Ann Thorac Surg 2020; 109: 1069-78. Doi: 10.1016/j.athroac sur.2019.11.019 Kissela BM, Eckman MH. Cost effectiveness or recombinant factor VIIa for treatment of intracerebral hemorrhage. BMC Neurology 2008; 8:17. Doi: 10.1186/1471-2377-8-17. Frank S, Oleyar MJ, Ness PM, Tobian AAR. Reducing unnecessary preoperative blood orders and cost by implementing an updated institution-specific maximum surgical blood order schedule and a remote electronic blood release system. Anesthesiology 2014; 121: 501-509. Doi: 10.1097/ALN 0000000000000000338. Tables Table 1: Blood Costs Utilized Product Estimated Acquisition Cost Model 1: Hospital Costs computed 3.8 x Acquisition Model 2: Published Total Hospital Costs (variable depending on models) PRBCs $275 Range: $150-$415 $1045 $1400 Range: $522-$1183 in 2010 FFP $75 $60.70 in 2011 $285 $410 Single report PC (apheresis) $635 $533.90 in 2011 $2413 $4281 Range: $3723-4436 in 2018 Cryo $350 Range: $114-$414 in 2016 $1330 $1500 Table 1: The values utilized for calculations of blood costs Pre-PBM and after PBM-Quantra clinical usage. Note there are three models. Acquisition costs alone are from sources, some ranging to 2011, 2019 adjusted by inflation for blood products over the last 20 years (averaged at 2.5% per year) to reflect 2024 dollars. Model #1 : A 3.8 multiplier applied to basic acquisition costs thus computing total hospital cost burden per unit, Model #2 reflects total hospital costs from various reported peer-reviewed estimates of total hospital cost burden. Some in Model# 2 are very similar to Model #1 and others quite different. Table 2: Costs per product by different models: Pre-PBM and after PBM-Quantra utilization Pre-PBM PBM-Quantra Period Mean units/ pt Units used in 500 pts Acqui. cost per unit/pt per 500 pts Model 1: Total cost= 3.8 x Acqui, per pt per 500 pts Total Hosp (published) cost per unit/pt 500 pts Mean units/pt Units used in 500 pts Acq. cost per unit/pt per 500 pts Model 1: 3.8 x Acqui, per pt per 500 pts Total Hosp. (published) coss per unit/pt per 500 pts RBCs 1.22 670 $275 $335.50 $224,785 $1045 $1274.90 $854,183 $1400 $1708 $1,144,360 .92 460 $275 $253 $126,500 $1045 $ 961.40 $480,700 $1400 $1288 $644,000 FFP .21 105 $75 $15.75 $7875.00 $285 $59.85 $29,925 $410 $86.10 $43,050 0.01 5 $75 $0.75 $375 $285 $2.85 $1,425 $410 $4.10 $2050 Plt-Pheresis .94 470 $635.00 $615.95 $298,450.00 $2423 $2277.62 $1,138,810 $4281 $4024.14 $2,012,070 .95 475 $635 $603.50 $301,625 $2413 $2,292.35 $1,146,175 $4281 $4066.95 $2,033,475 Cryo-5 pack .70 350 $350.00 $245.00 $122,500 $1330 $931 $465,500 $1500 $1050 $525,000 .64 320 $350 $224 $112,000 $1330 $851.20 $425,600 $1500 $960 $480,000 Total $643,610 $2,488418 $3,868,840 $540,500 $2,053,900 $3,159,525 There was a reduction in units utilized per patient in RBCs, FFP and Cryo whereas Plt utilization was unchanged. These did not reach statistical significance in each category but in aggregate when all Tx utilizations are combined there was significant reduction by use of the PBM-Quantra system. FFP was eliminated from clinical practice. The overall cost reduction in blood acquisition dollars (per 500 patients) was $103,110.00. In model 1, using total hospital costs for blood at 3.8-time acquisition costs the cost reduction in total hospital cost was $434,518.00 and in model 2, the reduction was $709,315.00. Table 3: Changes in Blood Product Ordered and Unutilized Pre-PBM to PBM-Quantra Period #units ordered but unutilized total cohort Units ordered unutilized/ 500 pts order/utilized Acqui. costs/500 Total hospital costs Model #1 per 500 Total hospital costs Model #2 per 500 #units ordered but unutilized total cohort Units ordered unutilized/ 500 pts Acqui costs/500 Total hospital costs Model #1 per 500 pts Total hospital costs Model #2 per 500 pts RBCs 1472 1037 2.07 O/U $285,175 $1,083,665 $1,451,800 137 269 0.54 O/U $73,975 $281,105 $376,600 FFP 697 585 1.17 O/U $43,875 $166,725 $239,850 5 10 0.02 O/U $750 $2850 $4,100 Plt 175 147 0.29 O/U $93,345 $354,711 $ 629,307 14 27 0.05 O/U $17,145 $65,151 $115,587 Cryo 129 108 0.22 O/U $37,800 143,640 $162,000 9 18 0.04 O/U $6,300 $23,940 $27,000 Total cost of ordered products $460,195 $1,923,761 $2,482,957 $98,170 $373,046 $523,287 Costs Unutilized Coag Products $175,020 $665,076 $1,031,157 $24,195 $91,941 $146,687 Table 3 Costs of products ordered and returned, unutilized or wasted as an entire cohort and then per 500 patients. The costs are computed in terms of acquisition alone and by Model #1 and Model #2 of total hospital costs for Pre-PBM and PBM-Quantra clinical utilization. The ordered to utilized ratio (O/U) is computed for each type of product per 500 patients. This is different than the crossmatch to transfusion C/T, ratio. Table 4: Pharmaceutical Costs Pre-PBM to PBM-Quantra Period Pharmaceutical Agent Cost/Pt dose % Pts X 500 pts/doses Total %Pts X 500 Pts/doses Total Difference PCC $2500 9.0 45 $112,500 11.0 55 $137,500 $25,000 Factor VIIa $6,300 3.2 16 $100,800 0 0 0 ($100,800) DDAVP $262 9.2 46 $12,052 4.0 20 $5,240 ($6,812) Fibrinogen $1000 0.2 1 $1000 2.0 20 $20,000 $19,000 Total $226,352 $162,740 $63,612 Table 4: Pharmaceutical costs, percent of patients that received the agents, and then calculated per 500 patients., followed by the costs computed per 500 patients for each pharmaceutical. This is done pre-PBM and post PBM-Quantra. The differences are subtracted and reported. Table 5: Summary of cost savings for blood utilized blood products (ordered and unutilized) plus pharmaceutical agents Acquistion Costs Model 1Total Hosp. Costs Model 2 Total Hosp. Costs Cost Blood Products Pre-PBM $643,610 $2,488,418 $3,868,840 Cost Blood Products PBM- Quantra $540,500 $2,053,900 $3,159,525 Change Pre- to PBM-Quantra $103,110 $434,518 $709, 315 Cost Unutilized Blood Products Pre-PBM $175,020 $665,076 $1,631,157 Cost Unutilized Blood Products PBM-Quantra $24,195 $91,941 $146,687 Change Pre to PBM $150,825 $573,135 $884,470 Pharmaceutical Cost Reductions (same for all models) $63,612 $ 63,612 $63,612 Total: Blood Product savings plus Pharmaceutical Savings $ 317,547 $1,071,265 $1,657,397 Table 5: The total reduction in costs incurred was for acquisition blood costs, Model 1 and Model 2. Note that pharmaceutical costs reduced was the same for each model, simply added in. All of these numbers are real but are broken out so they can be appreciated in different ways. In one sense the minimum cost savings demonstrated was $383,974, and by Model 2 a maximum demonstrated was $1,723,797. Additional Declarations Competing interest reported. Bruce D. Spiess, has disclosed he is medical director of HemoSonics LLC. He was not affiliated when the data was collected. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 27 Jul, 2025 Reviews received at journal 16 Jun, 2025 Reviews received at journal 06 Jun, 2025 Reviewers agreed at journal 02 Jun, 2025 Reviews received at journal 31 May, 2025 Reviewers agreed at journal 30 May, 2025 Reviewers agreed at journal 28 May, 2025 Reviewers invited by journal 28 May, 2025 Editor assigned by journal 31 Jan, 2025 Submission checks completed at journal 31 Jan, 2025 First submitted to journal 29 Jan, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5926543","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":409419236,"identity":"9d04dab9-dc8f-4292-8d12-e731562c33f6","order_by":0,"name":"Bruce D. Spiess","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYBACe/4DDAeAtBxMgJ8PSEjg02I4IwGsxRjMA7Ik2whpMbgBoRMbiNZiOIP34IEPf+rS+2c3H/78geGwBBsD88HbPHj9ci7h4My2w7kz7hxLkzgA1sKWbI1Pi2FDjsFh3oYDuQ03csyADjtcx8bAYyaNT4vBAaCWP0CHyd/I//wBYgv/N8JaGNiYEwxu5DBAHcbDhleL4Yy8hIO9bYcNN95IM5M4Y5AuwcbMZmw5B6/3zx7+8ONPnbzcjeTHHyoqrCX42Zsf3niDRwsDA4obDICYGa9yDC2jYBSMglEwCrAAAKCkTsqtMEk3AAAAAElFTkSuQmCC","orcid":"","institution":"University of Florida College of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Bruce","middleName":"D.","lastName":"Spiess","suffix":""},{"id":409419238,"identity":"bf2520c2-130c-46b4-bb52-e1c7169a48bb","order_by":1,"name":"Melissa A. Burger","email":"","orcid":"","institution":"University of Florida College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Melissa","middleName":"A.","lastName":"Burger","suffix":""},{"id":409419239,"identity":"a84ef829-b7b2-460b-8a29-b6b97174d1ca","order_by":2,"name":"Yong G. Peng","email":"","orcid":"","institution":"University of Florida College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yong","middleName":"G.","lastName":"Peng","suffix":""},{"id":409419241,"identity":"0bac1a82-1a1a-47da-af36-64f7797b6d08","order_by":3,"name":"Cynthia Garvan","email":"","orcid":"","institution":"University of Florida College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Cynthia","middleName":"","lastName":"Garvan","suffix":""},{"id":409419242,"identity":"33d4f545-18d8-41a1-8bc4-4f53b9b6d5ae","order_by":4,"name":"Reed W. Kamyszek","email":"","orcid":"","institution":"University of Florida College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Reed","middleName":"W.","lastName":"Kamyszek","suffix":""},{"id":409419243,"identity":"2d008ce1-9aa0-488b-9074-377bced36a7b","order_by":5,"name":"Luke P. Landolt","email":"","orcid":"","institution":"University of Florida College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Luke","middleName":"P.","lastName":"Landolt","suffix":""},{"id":409419244,"identity":"25f5e4c7-02aa-4a5d-83b3-7d3cb4fd2cb0","order_by":6,"name":"George Arnaoutakis","email":"","orcid":"","institution":"The University of Texas at Austin","correspondingAuthor":false,"prefix":"","firstName":"George","middleName":"","lastName":"Arnaoutakis","suffix":""}],"badges":[],"createdAt":"2025-01-29 20:53:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5926543/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5926543/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75393717,"identity":"c6e7d8fd-4e70-4661-874d-547b37c80ff9","added_by":"auto","created_at":"2025-02-04 06:04:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1506911,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5926543/v1/7eff5dd9-c7eb-4e83-93dc-a7dbba1141ee.pdf"}],"financialInterests":"Competing interest reported. Bruce D. Spiess, has disclosed he is medical director of HemoSonics LLC. He was not affiliated when the data was collected.","formattedTitle":"Quantra Q-plus Point of Care Coagulation Analysis Reduces Blood Product Cost Burden in Patients Undergoing Cardiac Surgery","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTransfusion remains variable in cardiac surgery. \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Patient blood management (PBM) has reduced blood utilization, yet transfusion behavior remains institution and physician dependent.\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e PBM guidelines are adopted in less than 50% of centers.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eApproximately 15\u0026ndash;30% of cardiac patients experience excessive bleeding. \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Major (\u0026ge;\u0026thinsp;5 units of PRBCs) and massive (\u0026ge;\u0026thinsp;10 units of PRBCs) bleeds account for 40% of PRBCs transfused.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Abnormal cardiac bleeding has been defined.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAdverse outcomes associated with PRBCs are focused upon, with coagulation component risks less well appreciated.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e PRBCs have a 13\u0026ndash;16% /unit increase in mortality and immunosuppression, myocardial infarction, pneumonia, lung dysfunction TRALI, volume overload (Transfusion Related Acute Cardiac Overload\u0026ndash;TACO), heart failure, renal dysfunction/failure, iron overload, prolonged intensive care unit (ICU) and hospital length of stay.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Fresh frozen plasma (FFP) and platelet concentrates (PC) have 10 and 6%/unit respective increased mortality as well as more TRALI and pneumonia than PRBCs.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e The risks of FFP, PC and cryoprecipitate (Cryo) are further reported. \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Without coagulation data, PCs are associated with increased mortality, stroke, and transfusion related acute lung injury (TRALI),\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e yet in one meta-analysis PC usage experienced improved outcomes when bleeding was treated.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Coagulation components are expensive and scarce (PC).\u003c/p\u003e \u003cp\u003eMajor and massive bleeding, causes further microvascular bleeding.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e When unguided therapy (\u0026ldquo;clinical judgement\u0026rdquo;) is invoked, the use of FFP leads to more PRBCs infused than if saline alone was utilized.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e FFP is less effective than PC or prothrombin complex concentrate (PCC) in bleeding.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Guidelines mandate data driven management. Monitoring coagulation is a PBM quality outcome variable to reduce adverse events, mortality and costs.\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Bleeding begets more bleeding.\u003c/p\u003e \u003cp\u003eThe use of coagulation components to prevent bleeding (prophylaxis) is contraindicated. The Cochrane Collaborative notes VET decreases blood transfusion, improves outcome and cuts costs.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe Quantra QPlus (HemoSonics, LLC, Triangle Park, NC) is an ultrasound-based, near real-time, cartridge-based, rapid, in-operating-room diagnostic platform.\u003csup\u003e\u003cspan additionalcitationids=\"CR21 CR22 CR23\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e The coagulation parameters measured by Quantra correlate with other VET and central laboratory coagulation assays (CLCA). \u003csup\u003e\u003cspan additionalcitationids=\"CR21 CR22 CR23\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Quantra\u0026rsquo;s rapid assessment of intraoperative coagulopathy reduces blood product transfusion and waste. \u003csup\u003e\u003cspan additionalcitationids=\"CR22 CR23 CR24 CR25\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Cost savings have yet to be quantified. Data from the accompanying article was leveraged to costs.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eStudy Design and Data Source\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe Burger et al. article is a single-center, retrospective, observational, cohort study, that quantified differences in blood component utilization, over ordering, discarded and returned to the blood bank-BB, but it did not examine costs. That study was deemed, retrospective an exempt study by the University of Florida (UFl) Institutional Review Board (IRB) (IRB 202002288 and IRB 202000163). \u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eData were extracted from the electronic medical record (EMR) Epic (Epic Systems Corporation, Madison, WI) and UFl-Society of Thoracic Surgeons (STS) database.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePatient Cohort\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBriefly, 253 consecutive adults undergoing elective or urgent cardiothoracic surgery who were managed with the Quantra Qplus system over a six-month period (2022 PBM-Quantra group) were compared to a cohort of 596 Pre-PBM (2019 pre-COVID-19) historical controls. Pre-PBM patients were managed with \u0026ldquo;clinical judgement\u0026rdquo;, CLCA testing and/or laboratory-based TEG 5000 (TEG, Haemonetics Inc, Braintree, Massachusetts, USA). The PBM-Quantra group of patients had a coagulopathy treatment algorithm available as a decision aid.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe number of units utilized Pre-PBM and PBM-Quantra for each product and pharmaceutical was divided by the number of patients (596 and 253) yielding a mean per patient, then computed per 500 patients. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePrimary Outcome\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe primary outcome compared cost of blood between the two groups. The acquisition and total hospital (models 1 and 2) cost burdens were calculated in aggregate and for 500 patients.\u003csup\u003e27-29\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSecondary outcomes \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe costs of excess ordering (PRBCs, PC, FFP and Cryo from BB) returned or wasted (100% Cryo not infused is wasted) was computed per patient and for 500 patients. \u0026nbsp; Although PRBCs and FFP can be returned to the BB, PC off the shaker for 4 hours may be discarded. There was no way of tracking which units returned to the BB were reutilized, versus discarded. All units brought to the OR were computed into the excess ordering costs (an overestimate). The hospital could recoup some revenue from PRBCs and FFP, but we do not know how much. \u0026nbsp;BB incurred costs in inventory restocking, tracking, storage, re-cross match, and these have not been cost modeled.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The average cost per unit of each product was calculated (Table 1), then multiplied by the total number of units. The difference in cost between the two groups was identified as the total reduction in unutilized or wasted products. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBlood Product Cost Calculation\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePRBCs\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eCosts were reported for acquisition (direct) and two models of total hospital cost (indirect), obtained from multiple sources (Table 1). \u0026nbsp;The American Association of Blood Bankers (AABB) reports to Congress via Health and Human Services (HHS) yearly with a chart of acquisition cost of PRBCs.\u003csup\u003e24\u003c/sup\u003e\u0026nbsp; The 2019 report was utilized for this manuscript.\u003csup\u003e24\u003c/sup\u003e We could not access more recent reports. In 2019 Q2, $248.00/unit was PRBC acquisition cost. \u0026nbsp; An academic source from 2011 listed PRBCs acquisition at $211.00/unit. \u003csup\u003e29.\u0026nbsp;\u003c/sup\u003eThe cost of PRBCs at Johns Hopkins University in 2017 was $220.00/unit. \u003csup\u003e30\u003c/sup\u003e These data as well as a reported range \u003csup\u003e25,29\u003c/sup\u003e created a best PRBC cost estimate (Table 1). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThat estimate was made by interpolating the average annual blood inflation rate (2.5%/annum over the last 20 years not compounded) \u003csup\u003e31\u003c/sup\u003e to calculate increases from 2011\u003csup\u003e27\u0026nbsp;\u003c/sup\u003eor 2019 (AABB/HHS data). \u0026nbsp;Translating the 2011 data of $211.00 to a 2024 estimate, yielded $279.00. \u0026nbsp;Using HHS 2019 data PRBCs interpolated for inflation, the 2024 cost was the same- $279.00. For the remainder of the manuscript, we rounded to $275.00, perhaps more of a 2022 estimate. Some will think the number high, and others low, it is at best our estimate. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFFP, PC and Cryo\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Less information is available for the average costs of FFP, PC and Cryo. Using the same 2.5% inflation rate, FFP cost was assigned $75.00/unit (2011 - $60.70) and PC at $635.00 (2011 -$534.00). \u003csup\u003e29\u003c/sup\u003e The HHS report is vague on coagulation product costs. \u0026nbsp;A hospital in Cleveland noted platelets at $1000.00/unit in 2013.\u003csup\u003e32\u0026nbsp;\u003c/sup\u003eCryo had one estimate at $350.00.\u003csup\u003e33\u0026nbsp;\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Precise acquisition costs are less important than decreases as blood utilization from Pre-PBM to PBM-Quantra periods. Total dollar reductions could be different if initial costs but percentage changes would be constant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTotal hospital costs are higher than acquisition.\u003csup\u003e\u0026nbsp;27-38\u003c/sup\u003e They include supply management, type and cross-matching, issuing, transport, delivery, clerical/technician time, \u0026nbsp;monitoring/management of adverse outcomes, BB outdating (not OR wastage), OR personnel time for transfusion, infusion IV, fluids, filters, OR and ICU clerical time. \u003csup\u003e27-38.\u003c/sup\u003e Estimates of total hospital costs range from 3.2 to 4.4-fold as multipliers of acquisition.\u003csup\u003e27-38\u0026nbsp;\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eModel 1 utilized a multiplier of acquisition, set at 3.8 times (mid-range) purchase price. \u0026nbsp;Model 2 utilized actual highest reported data published on total hospital costs. \u003csup\u003e27-38\u003c/sup\u003e The PC cost in model 2 was dramatically larger than model 1. \u003csup\u003e38\u0026nbsp;\u003c/sup\u003ePC treatment may be ineffective due to infusion of un-crossmatched PC.\u003csup\u003e38\u003c/sup\u003e Therefore more units of PC may be required to achieve a goal \u003csup\u003e38\u003c/sup\u003e We suspect, in cardiac surgery un-crossmatched PC is the practice. Teams do not have a defined goal or do not test whether PC reached the goal effective (target platelet count, or POC-VET platelet activity achieved). \u0026nbsp;Most likely clinicians only note whether bleeding has decreased.\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;A range for PC cost between $3373.00-$4476.00 for a single treatment is reported. \u003csup\u003e38\u003c/sup\u003e If PC refractoriness is combined with side effects (adverse events), estimates rise upwards of $5258.00 to $13,117.00 \u0026nbsp;in non- cardiac surgery.\u003csup\u003e38\u003c/sup\u003e No PC effectiveness or refractoriness data in cardiac surgery exist.\u003csup\u003e10\u003c/sup\u003e For model 2 analysis in this study PC costs were set at $4281.00, a mid-range .\u003csup\u003e38\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eAcquisition, and total hospital costs (models 1 and 2) together provide cost comprehensive understanding. No cost estimates of the burdens of adverse events ascribed to transfusion were calculated. \u0026nbsp;Estimating cost reductions in total medical care due to reduced adverse events is speculative at best and hard to judge in 500 patients. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePharmaceutical Costs\u003c/em\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePharmaceutical agents to enhance clot formation include prothrombin complex concentrate 4 factor (PCC), Factor VIIa (VIIA) desmopressin acetate (DDAVP) and fibrinogen concentrate (FIB). \u0026nbsp;Costs of drugs are negotiated between individual hospitals and pharmaceutical supply houses. Table 4 contains costs supported by published data or available on the internet as costs for each drug.\u003csup\u003e37, 39-43,47\u003c/sup\u003e A \u0026ldquo;full\u0026rdquo; dose for VIIa of 90ug/kg at a cost of $0.85-$1.30/ug (we chose 1.00/ug) and 80 kg (UFl patients are not usually70kg) was estimated at $6300.00. \u003csup\u003e39,40,47\u003c/sup\u003e Lower doses may have efficacy but when refractory bleeding was encountered in the pre-PBM period a maximum dose was given. For Fib the cost depends upon the dose, about $1.00 per mg. Table 4 showed a 1 gm dose but often 2-3 gm or more are infused.\u003csup\u003e42,43\u003c/sup\u003e PCC cost was calculated at a dose of 25ug/kg (factor IX level) for an 80 kg person. \u0026nbsp;Published costs varied between $2300.00 to above $4000.00 for warfarin reversal.\u003csup\u003e33,43\u003c/sup\u003e DDAVP costs are highly variable, and efficacy is unproven, 40ug in 10 ml is $168.00. However, that may not be effective, thus our estimate is $250.00.\u003csup\u003e41\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical Analysis\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStatistical analyses were performed using R version 4.2.1. SAS for the Berger manuscript. \u0026nbsp;Descriptive statistics were reported as frequencies with percentages for categorical variables and as means with standard deviations or medians with 25th and 75th percentiles for continuous variables, as necessary. Between groups, categorical variables were compared using chi-squared test or Fisher\u0026rsquo;s exact test and continuous variables compared using Mann-Whitney U tests. Periprocedural characteristics among pre-PBM patients versus PBM-Quantra usage were compared; variables showing p-value less than 0.05 were determined as significant. Due to the retrospective nature of the study, imbalance in the distribution of confounders was addressed using standardized differences. The cost differences were not tested for statistical significance since dollars differences are self-evident and not in need of statistical analysis. Although differences, for example in per case usage of PRBCs did not reach statistical significance in the population, usage of any particular blood component translated to a cost differences reported here. \u0026nbsp;We leave it to the reader to judge what level of cost differential is meaningful.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHandling of missing or invalid data\u0026nbsp;\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe primary and secondary outcome variables may have had missing blood records. \u0026nbsp; \u0026nbsp;If blood unit numbers were not recorded in the (EMR) it was assumed, they were unutilized. Errors in scanning unit numbers into the EMR may have occurred, but that was assumed to be the same in both groups. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIf unutilized PRBCs were brought back to the BB and utilized as a reassigned resource, what is the true cost to the hospital? \u0026nbsp;Some might assume the entire cost was recouped. Units out of inventory for 6-8 hours must create a cost. Clerical time was required to check them out and back into inventory. Any reassignment of a unit would have to go through type, cross, and clerical work all over again (doubling total hospital costs). \u0026nbsp;This is a source of error for the unutilized cost estimates. However, no accurate estimates of such costs exist. If RBC units are returned to BB the only cost recouped is acquisition, the least cost of all.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eReduction in Blood Product Usage\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe PBM-Quantra patients demonstrated reduced blood usage (Tables 2-5). \u0026nbsp; PRBCs decreased from 1.22 units to 0.92 units/pt. FFP fell from an already low level (0.21 units/pt) to non-existent (0.01 units/pt). \u0026nbsp;PC infusions were unchanged while Cryo was reduced from 0.70 to 0.64 units/pt. \u0026nbsp;The acquisition and total hospital (two models) cost changes are shown in Table 2. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Blood costs were substantial for 500 patients. Acquisition of PRBCs was $224,785.00 Pre-PBM reduced by 44% to $126,500.00 with PBM-Quantra utilization (Table 2). \u0026nbsp; A 95% reduction in FFP translated into acquisition costs dropping from $7875.00 to $375.00. \u0026nbsp;To a hospital, this may not seem to be a great deal of money, but FFP was rarely utilized Pre-PBM. Total hospital cost reductions created larger total potential savings (Table 2,3,4), but overall 44% percent reduction.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Decreases in transfusion provided fewer savings than the change in physician ordering (Table 3). \u0026nbsp;The savings due to changed ordering was 1.24-to-1.46-fold that for transfusion (Table 2,3,5). \u0026nbsp;The savings by changed ordering practices of coagulation components are 72.3% for acquisition alone, model 1, 72.3% and model 2, 70.3% (Table 3,5) \u0026nbsp; \u0026nbsp; Pharmaceuticals (Table 4, 5), decreased 55% in expenditures driven largely by VIIa reductions. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe computation of ordered to unutilized ratio (O/U) is different than crossmatch to transfusion ratio (C/T) (Table 3). The Pre-PBM C/T ratio for PRBCs was 2.54 and PBM-Quantra dropped to 1.6. The O/U ratio per patient for PRBCs was 2.07 Pre-PBM and 0.54 in the PBM-Quantra (P\u0026thinsp;\u0026lt;\u0026thinsp;.0001). Expressed differently, physicians ordered 60% more PRBCs than they utilized pre-PBM and only 35% more than they infused in PBM-Quantra. \u0026nbsp;For FFP, the O/U was 1.17 units/pt. Pre-PBM and 0.02 PBM-Quantra (P\u0026thinsp;\u0026lt;\u0026thinsp;.0001). We did not compute C/T ratios for coagulation components that not crossmatched. O/U serves to depict physician behavior. For PC the O/U was 0.29 units Pre-PBM and 0.05 in the PBM- Quantra (P\u0026thinsp;\u0026lt;\u0026thinsp;.0001). Lastly, the Cryo O/U was 0.22 in the Pre-PBM period and 0.04 in PBM- Quantra (P\u0026thinsp;\u0026lt;\u0026thinsp;.0001). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe use of pharmaceutical pro-thrombotic agents created savings (Table 4). \u0026nbsp;Factor VIIa was eliminated. \u0026nbsp;The use of FIB grew in lieu of Cryo. Overall, pharmaceutical costs were reduced by $130,012.00. Table 5 shows savings broken down into the sub-headings.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eBlood transfusion is variable between institutions and practitioners.\u003csup\u003e1-2\u003c/sup\u003e\u0026nbsp; PBM guidelines in place since 2007 are under adopted.\u003csup\u003e8,9\u003c/sup\u003e Level 1 evidence for over 17 years, has supported the use of POC-VET. \u003csup\u003e8-9\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eOur data demonstrate reductions in ordering, utilization, and pro-coagulant pharmaceuticals. \u0026nbsp;Once a PBM program utilizing the Quantra Qplus POC-VET analyzer was a part of everyday practice savings were many. \u0026nbsp;Overall cost reductions ranged from $317,547.00 to $1,657,397.00 in 500 patients. That translates to $635.00 to $3315.00/pt. \u0026nbsp;The lower number accounts for blood acquisition plus pharmaceuticals, whereas the highest number encompasses (model #2) total hospital costs overordering of blood plus the pharmaceutical costs. The total hospital costs, that we calculated in our tables, had two different models. Model number 1 multiplied hospital acquisition by a constant (3.8). \u0026nbsp; People reading can ascribe the factor they wish for their acquisition to total hospital costs. However, acquisition costs account for less than a third of total hospital costs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTotal hospital costs models are real, yet incomplete. The use of PRBCs in cardiac surgery is associated with a 13-16% increase in mortality per unit of blood.\u003csup\u003e3\u003c/sup\u003e What is the cost of mortality? FFP and PC have 10% and 6% mortality increase/unit.\u003csup\u003e3\u003c/sup\u003e Adverse events associated with transfusion include prolonged hospital stay, early readmission, prolonged ICU stay, renal dysfunction/failure, immunosuppression, increased hospital acquired infection, myocardial infarction, TRALI, TACO, bleeding and others. Each has associated costs, and many are not rare. \u0026nbsp;In successful PBM programs cost reductions are large, both because of reduced hospital stays and lowered adverse event costs but also because of fewer blood components used.\u003csup\u003e27,44,45\u003c/sup\u003e Province (Ontario, Canada) and statewide (Western Australia) efforts noted reductions of total health care costs between 37 (Ca) and 100 (Aus) million dollars annually. \u003csup\u003e43,44\u003c/sup\u003e Neither included POC-VET for containment of coagulation blood product usage, wastage or change in physician behavior. More savings can be created. Our data did not estimate cost reductions if adverse events were decreased.\u003csup\u003e27,44,45\u003c/sup\u003e Much larger series or prospective trials are necessary to define adverse event reductions. However, our data speak for themselves without becoming speculative on adverse event costs.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;By reducing utilization approximately 44% of acquisition and total hospital blood costs were saved. Approximately 20-25% of blood collected is utilized in cardiac surgery. Reducing use alleviates shortages. \u0026nbsp;There must be secondary macro-economic health care cost reductions when shortages are alleviated. One example of indirect costs incurred when shortages occur is that elective surgeries may be postponed creating far reaching, personal patient and family inconvenience, social and employment implications as well as hospital and medical care costs.\u003c/p\u003e\n\u003cp\u003eHemorrhage after cardiac surgery occurs in 6-15% of cases with variable frequency of return to OR for bleeding (1.5-7%).\u003csup\u003e42,46\u003c/sup\u003e Hemorrhage is associated with prolonged hospital stay and many adverse events.\u003csup\u003e42,46\u003c/sup\u003e\u0026nbsp; \u0026nbsp;Estimated costs for excessive bleeding are not inclusive of blood product costs have been reported.\u003csup\u003e46\u0026nbsp;\u003c/sup\u003eIn 2006 the additional incremental cost for hemorrhage was E6251.00 Euros or \u0026nbsp;$33,338.00 (Australian dollars) without including blood product or return to OR costs.\u003csup\u003e42, 46\u0026nbsp;\u003c/sup\u003e Monitoring technology that rapidly identifies the causes of bleeding, \u0026nbsp;reducing excessive bleeding, should have far reaching cost reductions beyond just the blood costs we investigated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBlood components billed are not always reimbursed. Often, blood is part of bundled payments for a specific surgical procedure (CABG for example). In other cases, the first 3 units of blood are not reimbursed. \u0026nbsp;A single transfusion charge per day is often all that is paid, thus not reimbursing for individual units infused. \u0026nbsp; Blood costs may be a cost center, non-recoverable expenses in cardiac surgery. \u0026nbsp;By invoking a plan of PBM with a POC-VET, UFl dramatically reduced its costs for blood and expensive pharmaceuticals.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe changes in physician behavior by reducing over ordering had the greatest cost reduction. \u0026nbsp;To stock a \u0026ldquo;cooler\u0026rdquo; with cold packs, check the blood out of the BB, do clerical documentation, have them checked in to the OR, crosschecked by nursing and anesthesiology all requires personnel time. That work product has never been cost modeled. When blood is returned to the BB clerical time is required. \u0026nbsp;The fact that extra units were sent and not utilized meant that those units were out of inventory for 6-8 hours. \u0026nbsp;If the BB maintains a given inventory, then checking those units out of inventory mandated the hospital purchasing more per year to maintain a stable inventory. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThat should be modeled. At UFl 3-4 cardiac ORs work per day with 1-3 cases per OR. For the sake of example only (not included in our reported cost data), if each OR ordered 4 units PRBCs (which was commonly done in 2019) and held them for 6-8 hours that would mean 12-16 units (assuming only 1 case per OR) would be outside the BB. Pre-PBM, 1.24 PRBC units/case were utilized meaning that 2.76 were returned to the BB. Assuming (conservatively) 10 units per day out of inventory, unutilized, for 250 (number of working days per year) an extra 2500 PRBC units would need to be ordered to maintain a stable inventory. When that level of extra ordering is multiplied by acquisition cost ($275) the added BB cost for maintenance of inventory is $687,500. If the blood is out of inventory for only 33% of time, one cannot imply that only 33% of the inventory maintenance cost is required. \u0026nbsp;Somehow the BB has become accustomed to the over ordering and probably does not focus on this added cost created by physician behavior. That is the amount of money that the BB would have to expend to simply support the habit of the cardiac surgical team to have PRBCs sequestered in coolers in their ORs, for their convenience. With most of those units being unutilized that cost level, unreimbursed to the hospital, should be of interest for administrators.\u003c/p\u003e\n\u003cp\u003eThat was not included in our tables. The point is that units unutilized create hidden costs. \u0026nbsp;Even with the best system, some that are sent to the OR do outdate. \u0026nbsp;PRBCs are lost due to coolers not being returned when a case is concluded. Furthermore, the outdating of PC and Cryo represents true wastage. BB reports show that about 2-3% of blood outdates within the BB. BB does not report what is wasted outside of their control. Transfusion committees may follow such numbers. We cannot find a national average of this for cardiac centers.\u003c/p\u003e\n\u003cp\u003eThe crossmatch to transfusion ratio (C/T) is a measure of appropriateness of ordering used to benchmark surgical ordering. Best practices of C/T ratio show that the top 10% of hospitals have a C/T ratio of \u0026lt;1.5, 1:1 is ideal, and below 2 is a goal.\u003csup\u003e48\u003c/sup\u003e Pre-PBM the C/T ratio in this data was 2.54 and with PBM-Quantra the C/T ratio became 1.60. \u0026nbsp;How can coagulation technology change the C/T ratio for PRBCs? \u0026nbsp; The answer probably lies in an overall focus on PBM by a team that has learned the value of appropriate conservation of a scarce and costly resource.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe ordered to unutilized (O/U) ratio decrease was dramatic, (74% reduction). These data show a reduction in anticipatory (\u0026ldquo;clinical judgement\u0026rdquo;) behavior. That change saved more money than the reduction in either overall blood usage or expensive medications.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe public might react by knowing that their altruistically donated blood components were wasted. \u0026nbsp;The United States experiences predictable and unpredictable blood shortages. \u0026nbsp;The COVID-19 pandemic created a widespread, predicted, and preventable blood shortage.\u003csup\u003e46\u0026nbsp;\u003c/sup\u003eCalls for adoption of PBM standards went unheeded in the United States.\u003csup\u003e2\u003c/sup\u003e Not only can a PBM program with POC-VET reduce utilization, but changed physician behavior created less unnecessary ordering, wastage and pharmaceutical costs. These behavior changes are direct dollar gains for the hospital.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePBM programs have shown cost savings, being approximately 20-40% return on investments in the first year, with overall reductions in morbidity and mortality.\u003csup\u003e2,43,44\u003c/sup\u003e\u0026nbsp; In both Ontario, Canada and Western Australia the institution of PBM programs reduced health care costs, length of stay, mortality, and many morbidities.\u003csup\u003e43,44\u003c/sup\u003e The use of PBM-Quantra is a potential triple or greater win: saving money, reducing \u0026nbsp;adverse events, good for public health (decreasing adverse events and reducing blood shortages) as well as the individual patients. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe cost of implementing a PBM program is known.\u003csup\u003e2,43,44\u003c/sup\u003e PBM involves coordinated education, data acquisition/analysis, anemia therapy, intraoperative red cell salvage, reduction of bleeding and coagulation therapeutic POC-VET individualized decision making. \u0026nbsp;Practitioners wish to do the right thing when they are informed and given the tools.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe tools for POC-VET are not expensive. Utilizing three test cartridges per case, the cost is estimated to be approximately $250.00-$300.00/case. Amortized for 500 patients that amounts to a $125,000.00-$150.000.00 cost for running tests. Paying $150,000.00 to save $317,547.00 to $1,657,397.00 makes sense. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eLimitations\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eUFl is a large tertiary care center with residents, fellows and a very complex cardiac case mix. Because of the teaching nature of the medical center, cases may take longer than at private centers. Bleeding is surgeon, team and institution dependent as well as based upon the risk presented by the case mix. UFl is a regional complex aortic surgery center, that does fewer heart transplantations or device implantations than other centers. Protocols for heparin, protamine, and antifibrinolytics utilized here might differ as well as there was little FFP utilized prior to PBM-Quantra with none afterwards. \u0026nbsp;Cardiac hospitals that infuse considerable FFP may encounter more cost savings other series with Quantra have noted the abolition of FFP.\u003csup\u003e20,21,22\u003c/sup\u003e\u0026nbsp; \u0026nbsp;At UFl use of FIB and PCC were evolving during the study period. The data reported represents a snapshot in time from one center. One may not be able to generalize the cost savings to other centers. \u0026nbsp; We did not mandate nor police the use of the algorithm. A different study would need to be done to see if close adherence to an algorithm or the \u0026ldquo;best\u0026rdquo; algorithm could further enhance savings.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe institution of a PBM, POC-VET system in cardiac surgery was cost effective. It decreased costs for blood (acquisition and total hospital costs), unutilized blood and pharmaceuticals. With a minimum cost saving of \u003cspan\u003e$\u003c/span\u003e635.00/case and an upper savings of \u003cspan\u003e$\u003c/span\u003e3,315.00/case the institution of a POC-VET program is of value to hospitals doing heart surgery. Blood is a cost center. The savings created ought to be direct gains to the institution. If published adverse event rate reductions from PBM programs were to hold true with this intervention the cost saving just reported would be magnified.\u003c/p\u003e \u003cp\u003ePrior to the institution of real time Quantra, POC-VET individualized coagulation decision making was not possible. PBM stresses individualized medicine. Today not only is coagulopathy able to be rapidly diagnosed and appropriately treated but it is capable of being handled in a highly cost-effective way that will improve hospital bottom lines, reduce blood costs, relieve blood shortages, decrease health care waste, individualize care, be good for the patient and be good for public health.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAABB - American Association of Blood Bankers\u003c/p\u003e\n\u003cp\u003eAus - Australia\u003c/p\u003e\n\u003cp\u003eBB - Blood Bank\u003c/p\u003e\n\u003cp\u003eCa - Canada\u003c/p\u003e\n\u003cp\u003eC/T- Crossmatch to transfusion ratio\u003c/p\u003e\n\u003cp\u003eCLCA - Central laboratory coagulation assays\u003c/p\u003e\n\u003cp\u003eCryo - Cryoprecipitate\u003c/p\u003e\n\u003cp\u003eDDAVP - D-8-arginine vasopressin\u003c/p\u003e\n\u003cp\u003eEMR - Electronic medical record\u003c/p\u003e\n\u003cp\u003eVIIa - Factor VIIa\u003c/p\u003e\n\u003cp\u003eFFP - Fresh frozen plasma\u003c/p\u003e\n\u003cp\u003eFIB - Fibrinogen Concentrate\u003c/p\u003e\n\u003cp\u003eHHS - Health and Human Services\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eICU - Intensive care unit\u003c/p\u003e\n\u003cp\u003eIRB - Institutional review board\u003c/p\u003e\n\u003cp\u003eNC - North Carolina\u003c/p\u003e\n\u003cp\u003eOR - Operating room\u003c/p\u003e\n\u003cp\u003ePt - Patient\u003c/p\u003e\n\u003cp\u003ePBM - Patient blood management\u003c/p\u003e\n\u003cp\u003ePC - Platelet concentrate\u003c/p\u003e\n\u003cp\u003ePCC - Prothrombin complex concentrate (4 factor)\u003c/p\u003e\n\u003cp\u003ePOC - Point of care\u003c/p\u003e\n\u003cp\u003eQ-plus- Quantra Q-plus system\u003c/p\u003e\n\u003cp\u003eQALY - Quality Added Life Year\u003c/p\u003e\n\u003cp\u003eSAS - Statistical Analysis System\u003c/p\u003e\n\u003cp\u003eSTS - Society of Thoracic Surgeons\u003c/p\u003e\n\u003cp\u003eTACO - Transfusion associated cardiac overload\u003c/p\u003e\n\u003cp\u003eTRALI - Transfusion related acute lung injury\u003c/p\u003e\n\u003cp\u003eUS - United States\u003c/p\u003e\n\u003cp\u003eUFl - The University of Florida\u003c/p\u003e\n\u003cp\u003eVET - Visco-elastic technology\u003c/p\u003e\n\u003cp\u003ePRBCs - Packed red blood cells\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eBruce D. Spiess, has disclosed he is medical director of HemoSonics LLC. He was not affiliated when the data was collected.\u003c/p\u003e\n\u003ch2\u003eFunding sources:\u003c/h2\u003e\n\u003cp\u003enone, in-house funded\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eA: Conceived and designed the analysis: BS, CG, MB, YP,GAB: Collected Data: MB, YP, GAC: Performed the analysis: CG, MB, BSD: Wrote the paper: MB, BDS, YP, CG, LL, RK\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eData is on file at University of Florida and in the STS database at Universiyt of Florida\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eRobich MP, Koch CG, Johnston DR, et al. Trends in blood utilization in United States cardiac surgical patients. \u003cem\u003eTransfusion\u003c/em\u003e 2015;55(4):805-814.\u003c/li\u003e\n \u003cli\u003eHofmann A, Shande A, Blumberg N, Hamdorf J, Isbister JP, Gross I. 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Epub 2021 Mar 27/800-3350.\u003c/li\u003e\n \u003cli\u003eBlumberg N, Asante AA, Nguyen PLT, Heal JM. Platelet transfusions: The good the bad and the ugly. \u003cem\u003eAnesth Analg\u003c/em\u003e 2024; 138: 921-924. Doi: 10.1213. 0000000000006918.\u003c/li\u003e\n \u003cli\u003eBarnett CL, Mladsi D, Vredenburg M, Aggarwal K. Cost estimate of platelet transfusion in the United States for patients with chronic liver disease and associated thrombocytopenia undergoing elective procedures. \u003cem\u003eJournal of Medical Economics\u003c/em\u003e 2018; 21: 827-834. Doi: 10.1080/13696998.2018.1490301\u003c/li\u003e\n \u003cli\u003eOkerberg CK, Williams III LA, Kilgore CH, et.al. Cryoprecipitate AHF v. fibrinogen concentrates for fibrinogen replacement in acquired bleeding patients--an economic evaluation. \u003cem\u003eVox Sang\u003c/em\u003e 2016; 111: 292-298. Doi: 10.1111/vox.12417.Epub 2016 Jun 1.\u003c/li\u003e\n \u003cli\u003eKissela BM, Eckman MH. Cost effectiveness of recombinant factor VIIa for treatment of intracerebral hemorrhage. \u003cem\u003eBMC Neurology\u003c/em\u003e 2008; 8:17, 1-9. Doi 10.1186/1471-2377-8-17.\u003c/li\u003e\n \u003cli\u003eKerr M. Protocol for factor VIIa reduces costs, increases off-label use. February 21,2002 Society of Critical Care Medicine. Viewed 9/2/2024. HTTP//Medscape.com/view article/552546? Form=fpf.\u003c/li\u003e\n \u003cli\u003eWang C, Lebedeva V, Yang J. et al. Desmopressin to reduce periprocedural bleeding and transfusion: a systematic review and meta-analysis. \u003cem\u003eBMC Perioperative Med\u003c/em\u003e. 2024;5: 13. Doi 10.1186/s13741-023-00358-4.\u003c/li\u003e\n \u003cli\u003ehttps://www.google.com/search?q=ddavp+cardiac+surgery+cost+cardiac\u0026amp;sca_esv=197713b87bf2beb1\u0026amp;sca\u003c/li\u003e\n \u003cli\u003eTanaka KA, Mazzefi MA, Strauss ER, Szlam F, Guzzetta NA. Computational simulation and comparison of prothrombin complex concentrate dosing schemes for warfarin reversal in cardiac surgery. \u003cem\u003eJ Anesth\u003c/em\u003e 2016; 30: 369-376 DOI 10.1007/s00540-015-2128-3.\u003c/li\u003e\n \u003cli\u003eChristensen MC, Krapf S, Kempel A, von Heymann C. Costs of excessive postoperative hemorrhage in cardiac surgery. \u003cem\u003eJ Thorac Cardiovasc Surg\u003c/em\u003e. 2009;338(3):687-693.\u003c/li\u003e\n \u003cli\u003ePavenski K, Howell A, Mazer D, et. al. ONTraC: A 20-year history of a successfully coordinated provincewide patient blood management program: Lessons learned and goals Achieved. \u003cem\u003eAnesth Analg\u003c/em\u003e 2022;135: 448-458. Doi; 10.1213/ANE.0000000000006065.\u003c/li\u003e\n \u003cli\u003eLeahy MF, Hofmann A, Towler S, et.al. Improved outcomes and reduced costs with a health-system-wide patient blood management program: A retrospective observational management program: A retrospective observational study in four major adult tertiary -care hospitals. \u003cem\u003eTransfusion\u003c/em\u003e 2017; 57: 1347-1358. Doi: 10.1111/trf.14006\u003c/li\u003e\n \u003cli\u003eShander A, Goobie SM, Warner MA, et.al. Essential role of patient blood management oin a pandemic: A call to action. \u003cem\u003eAnesth Analg\u003c/em\u003e 2020;51: 74-85. Doi: 10.1213. ANE00000000000000004844.\u003c/li\u003e\n \u003cli\u003eNewcomb AE, Dignan R, McEldusff P, Pearse EJ, Bannon P. Bleeding after cardiac surgery is associated with an increase in the total cost of the hospital stay. \u003cem\u003eAnn Thorac Surg\u003c/em\u003e 2020; 109: 1069-78. Doi: 10.1016/j.athroac sur.2019.11.019\u003c/li\u003e\n \u003cli\u003eKissela BM, Eckman MH. Cost effectiveness or recombinant factor VIIa for treatment of intracerebral hemorrhage. \u003cem\u003eBMC Neurology\u003c/em\u003e 2008; 8:17. Doi: 10.1186/1471-2377-8-17.\u003c/li\u003e\n \u003cli\u003eFrank S, Oleyar MJ, Ness PM, Tobian AAR. Reducing unnecessary preoperative blood orders and cost by implementing an updated institution-specific maximum surgical blood order schedule and a remote electronic blood release system. \u003cem\u003eAnesthesiology\u003c/em\u003e 2014; 121: 501-509. Doi: 10.1097/ALN 0000000000000000338.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 638px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1: Blood Costs Utilized\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProduct\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated Acquisition Cost\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 1:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eHospital Costs computed\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e3.8 x Acquisition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 2:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePublished Total Hospital Costs (variable depending on models)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePRBCs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e$275\u003c/p\u003e\n \u003cp\u003eRange: $150-$415\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e$1045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e$1400\u003c/p\u003e\n \u003cp\u003eRange:\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$522-$1183 in 2010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFFP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e$75\u003c/p\u003e\n \u003cp\u003e$60.70 in 2011\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e$285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e$410\u003c/p\u003e\n \u003cp\u003eSingle report\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePC (apheresis)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e$635\u003c/p\u003e\n \u003cp\u003e$533.90 in 2011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e$2413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e$4281\u003c/p\u003e\n \u003cp\u003eRange: $3723-4436\u003c/p\u003e\n \u003cp\u003ein 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCryo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e$350\u003c/p\u003e\n \u003cp\u003eRange: $114-$414\u003c/p\u003e\n \u003cp\u003ein 2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e$1330\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e$1500\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e The values utilized for calculations of blood costs Pre-PBM and after PBM-Quantra clinical usage.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNote there are three models. \u003cstrong\u003eAcquisition\u003c/strong\u003e costs alone are from sources, some ranging to 2011, 2019 adjusted by inflation for blood products over the last 20 years (averaged at 2.5% per year) to reflect 2024 dollars. \u0026nbsp;\u003cstrong\u003eModel #1\u003c/strong\u003e: A 3.8 multiplier applied to basic acquisition costs thus computing total hospital cost burden per unit, \u003cstrong\u003eModel #2\u003c/strong\u003e reflects total hospital costs from various reported peer-reviewed estimates of total hospital cost burden. Some in Model# 2 are very similar to Model #1 and others quite different.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003eTable 2: \u0026nbsp;Costs per product by different models: Pre-PBM and after PBM-Quantra utilization\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"940\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 46.2766%;\" colspan=\"5\"\u003e\u003cstrong\u003ePre-PBM \u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 42.8723%;\" colspan=\"5\"\u003e\u003cstrong\u003ePBM-Quantra Period\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean units/\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ept\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Units used in 500 pts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcqui. cost per unit/pt\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eper 500 pts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 1: Total cost= 3.8 x Acqui, per pt\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eper 500 pts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Hosp (published) cost per unit/pt\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e500 pts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean units/pt\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnits used in 500 pts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcq. cost per unit/pt\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eper 500 pts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 1:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e3.8 x Acqui,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eper pt\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eper 500 pts\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Hosp. (published) coss per unit/pt\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eper 500 pts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRBCs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e670\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e$275\u003c/p\u003e\n \u003cp\u003e$335.50\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$224,785\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e$1045 $1274.90\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$854,183\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e$1400\u003c/p\u003e\n \u003cp\u003e$1708\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$1,144,360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e460\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e$275\u003c/p\u003e\n \u003cp\u003e$253\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$126,500\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e$1045\u003c/p\u003e\n \u003cp\u003e$ 961.40\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$480,700\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e$1400\u003c/p\u003e\n \u003cp\u003e$1288\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$644,000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFFP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e$75\u003c/p\u003e\n \u003cp\u003e$15.75\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$7875.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e$285\u003c/p\u003e\n \u003cp\u003e$59.85\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$29,925\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e$410\u003c/p\u003e\n \u003cp\u003e$86.10\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$43,050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e$75\u003c/p\u003e\n \u003cp\u003e$0.75\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e$285\u003c/p\u003e\n \u003cp\u003e$2.85\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$1,425\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e$410\u003c/p\u003e\n \u003cp\u003e$4.10\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$2050\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlt-Pheresis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e470\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e$635.00\u003c/p\u003e\n \u003cp\u003e$615.95\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$298,450.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e$2423\u003c/p\u003e\n \u003cp\u003e$2277.62\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$1,138,810\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e$4281\u003c/p\u003e\n \u003cp\u003e$4024.14\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$2,012,070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e475\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e$635\u003c/p\u003e\n \u003cp\u003e$603.50\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$301,625\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e$2413\u003c/p\u003e\n \u003cp\u003e$2,292.35\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$1,146,175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e$4281\u003c/p\u003e\n \u003cp\u003e$4066.95\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$2,033,475\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCryo-5 pack\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e$350.00\u003c/p\u003e\n \u003cp\u003e$245.00\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$122,500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e$1330\u003c/p\u003e\n \u003cp\u003e$931\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$465,500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e$1500\u003c/p\u003e\n \u003cp\u003e$1050\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$525,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e$350\u003c/p\u003e\n \u003cp\u003e$224\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$112,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e$1330\u003c/p\u003e\n \u003cp\u003e$851.20\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$425,600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e$1500\u003c/p\u003e\n \u003cp\u003e$960\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e$480,000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$643,610\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$2,488418\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$3,868,840\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$540,500\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$2,053,900\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$3,159,525\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThere was a reduction in units utilized per patient in RBCs, FFP and Cryo whereas Plt utilization was unchanged. \u0026nbsp;These did not reach statistical significance in each category but in aggregate when all Tx utilizations are combined there was significant reduction by use of the PBM-Quantra system. \u0026nbsp;FFP was eliminated from clinical practice. The overall cost reduction in blood acquisition dollars (per 500 patients) was $103,110.00. In model 1, using total hospital costs for blood at 3.8-time acquisition costs the cost reduction in total hospital cost was $434,518.00 and in model 2, the reduction was $709,315.00.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"943\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 99.7879%;\" colspan=\"11\"\u003e\u003cstrong\u003eTable 3: \u0026nbsp; \u0026nbsp; Changes in Blood Product Ordered and Unutilized Pre-PBM to PBM-Quantra Period\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1403%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.1597%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e#units\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eordered but unutilized \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003etotal cohort\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.9906%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnits ordered unutilized/ 500 pts order/utilized\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.9712%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcqui.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ecosts/500\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.034%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal hospital costs Model #1 per 500\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.034%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal hospital costs Model #2 per 500\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.3319%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e#units ordered but unutilized total cohort\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.5026%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnits ordered unutilized/ 500 pts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0775%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcqui costs/500\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.2466%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal hospital costs Model #1 per 500 pts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.5026%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal hospital costs Model #2 per 500 pts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1403%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRBCs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.1597%;\"\u003e\n \u003cp\u003e1472\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.9906%;\"\u003e\n \u003cp\u003e1037\u003c/p\u003e\n \u003cp\u003e2.07 O/U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.9712%;\"\u003e\n \u003cp\u003e$285,175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.034%;\"\u003e\n \u003cp\u003e$1,083,665\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.034%;\"\u003e\n \u003cp\u003e$1,451,800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.3963%;\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.3318%;\"\u003e\n \u003cp\u003e269\u003c/p\u003e\n \u003cp\u003e0.54 O/U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0775%;\"\u003e\n \u003cp\u003e$73,975\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.2466%;\"\u003e\n \u003cp\u003e$281,105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.5026%;\"\u003e\n \u003cp\u003e$376,600\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1403%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFFP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.1597%;\"\u003e\n \u003cp\u003e697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.9906%;\"\u003e\n \u003cp\u003e585\u003c/p\u003e\n \u003cp\u003e1.17 O/U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.9712%;\"\u003e\n \u003cp\u003e$43,875\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.034%;\"\u003e\n \u003cp\u003e$166,725\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.034%;\"\u003e\n \u003cp\u003e$239,850\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.3963%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.3318%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e0.02 O/U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0775%;\"\u003e\n \u003cp\u003e$750\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.2466%;\"\u003e\n \u003cp\u003e$2850\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.5026%;\"\u003e\n \u003cp\u003e$4,100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1403%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlt\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.1597%;\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.9906%;\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003cp\u003e0.29 O/U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.9712%;\"\u003e\n \u003cp\u003e$93,345\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.034%;\"\u003e\n \u003cp\u003e$354,711\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.034%;\"\u003e\n \u003cp\u003e$ 629,307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.3963%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.3318%;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003cp\u003e0.05 O/U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0775%;\"\u003e\n \u003cp\u003e$17,145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.2466%;\"\u003e\n \u003cp\u003e$65,151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.5026%;\"\u003e\n \u003cp\u003e$115,587\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1403%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCryo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.1597%;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.9906%;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003cp\u003e0.22 O/U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.9712%;\"\u003e\n \u003cp\u003e$37,800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.034%;\"\u003e\n \u003cp\u003e143,640\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.034%;\"\u003e\n \u003cp\u003e$162,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.3963%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.3318%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003cp\u003e0.04 O/U\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0775%;\"\u003e\n \u003cp\u003e$6,300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.2466%;\"\u003e\n \u003cp\u003e$23,940\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.5026%;\"\u003e\n \u003cp\u003e$27,000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1403%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.1597%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.9906%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.9712%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.034%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.034%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.3963%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.3318%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0775%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.2466%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.5026%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1403%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal cost of ordered products\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.1597%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.9906%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.9712%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$460,195\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.034%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$1,923,761\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.034%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$2,482,957\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.3963%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.3318%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0775%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$98,170\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.2466%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$373,046\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.5026%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$523,287\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1403%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCosts Unutilized\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCoag Products\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.1597%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.9906%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.9712%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$175,020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.034%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$665,076\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.034%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$1,031,157\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.3963%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.3318%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0775%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$24,195\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.2466%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$91,941\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.5026%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$146,687\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCosts of products ordered and returned, unutilized or wasted as an entire cohort and then per 500 patients. The costs are computed in terms of acquisition alone and by Model #1 and Model #2 of total hospital costs for Pre-PBM and PBM-Quantra clinical utilization. The ordered to utilized ratio (O/U) is computed for each type of product per 500 patients. \u0026nbsp;This is different than the crossmatch to transfusion C/T, ratio.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Pharmaceutical Costs Pre-PBM to \u0026nbsp;PBM-Quantra Period\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"946\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePharmaceutical Agent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCost/Pt dose\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% Pts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eX 500 pts/doses\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%Pts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eX 500 Pts/doses\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDifference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePCC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e$2500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e$112,500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e$137,500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e$25,000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor VIIa\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e$6,300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e$100,800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e($100,800)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDDAVP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e$262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e$12,052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e$5,240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e($6,812)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFibrinogen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e$1000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e$1000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e$20,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e$19,000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e$226,352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e$162,740\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e$63,612\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4: Pharmaceutical costs, percent of patients that received the agents, and then calculated per 500 patients., followed by the costs computed per 500 patients for each pharmaceutical. \u0026nbsp;This is done pre-PBM and post PBM-Quantra. \u0026nbsp;The differences are subtracted and reported. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Summary of cost savings for blood utilized blood products (ordered and unutilized)\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eplus pharmaceutical agents\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"947\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 413px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eAcquistion Costs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eModel 1Total Hosp. Costs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eModel 2 Total Hosp. Costs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 413px;\"\u003e\n \u003cp\u003eCost Blood Products Pre-PBM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e$643,610\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e$2,488,418\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e$3,868,840\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 413px;\"\u003e\n \u003cp\u003eCost Blood Products PBM- Quantra\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e$540,500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e$2,053,900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e$3,159,525\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 413px;\"\u003e\n \u003cp\u003eChange Pre- to PBM-Quantra\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$103,110\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$434,518\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$709, 315\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 413px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 413px;\"\u003e\n \u003cp\u003eCost Unutilized Blood Products Pre-PBM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e$175,020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e$665,076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e$1,631,157\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 413px;\"\u003e\n \u003cp\u003eCost Unutilized Blood Products PBM-Quantra\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e$24,195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e$91,941\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e$146,687\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 413px;\"\u003e\n \u003cp\u003eChange Pre to PBM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$150,825\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$573,135\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$884,470\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 413px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 413px;\"\u003e\n \u003cp\u003ePharmaceutical Cost Reductions (same for all models)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$63,612\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$ 63,612\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$63,612\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 413px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 413px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal: Blood Product savings plus Pharmaceutical Savings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$ 317,547\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$1,071,265\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e$1,657,397\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u003c/strong\u003e The total reduction in costs incurred was for acquisition blood costs, Model 1 and Model 2. \u0026nbsp; Note that pharmaceutical costs reduced was the same for each model, simply added in. All of these numbers are real but are broken out so they can be appreciated in different ways. \u0026nbsp;In one sense the minimum cost savings demonstrated was $383,974, and by Model 2 a maximum demonstrated was $1,723,797.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cardiac surgery, Transfusion, Cost, Patient Blood Management, Transfusion, Coagulation, Sonorheometry, Quantra, Point of Care","lastPublishedDoi":"10.21203/rs.3.rs-5926543/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5926543/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eDespite long standing blood management guidelines for cardiac surgery, VET is underutilized, and fewer institutions employ new real-time operating room-based POC-VET. We evaluated the cost effects of POC-VET coagulopathy management at a single institution when the technology was implemented.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypothesis: \u003c/strong\u003eThe hypothesis was that POC-VET-guided reduction in blood transfusion, wastage, and pro-thrombotic pharmaceuticals generated cost savings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e 596 patients were analyzed from a time prior to POC-VET coagulation management and 253 after implementing the Quantra Qplus system (Hemosonics LLC). Blood component and pharmaceutical costs were estimated from available literature to develop blood acquisition costs, two models of total hospital blood costs and pharmaceutical costs. All models were standardized to 500 patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Estimated direct acquisition costs of components were reduced by 16%, from $643,610 (Pre-PBM) to $540,500 (PBM-Quantra) per 500 patients. Estimated total hospital costs of transfusions were reduced between 17.5-18.3% (Model 1: $2,488,418 Pre-PBM vs. $2,053,900 PBM-Quantra; Model 2: $3,868,840 Pre-PBM vs. $3,159,525 PBM-Quantra). Estimated direct costs for blood component wastage were reduced by 86.2% ($175,000 PRE-PBM vs $24,195 PBM-Quantra per 500 patients). Estimated total costs for blood product were reduced by 86.2-85.8% (Model 1: $665,076 Pre-PBM vs. $91,941 PBM-Quantra; Model 2: $1,031,157 Pre-PBM Quantra vs $146,687 PBM-Quantra, all per 500 patients.) \u0026nbsp;Pharmaceutical costs were reduced from $226,353 to $162,740 per 500 patients. Overall combined amortize savings per patient were between $635 to $3,315.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: \u0026nbsp;This study showed that adoption of the Quantra Qplus POC-VET resulted in significant cost savings of unnecessary transfusions, less ordering of coagulation components and pro-coagulant pharmaceuticals. Cost containment and effective allocation of limited resources such as blood component is paramount to PBM.\u003c/p\u003e","manuscriptTitle":"Quantra Q-plus Point of Care Coagulation Analysis Reduces Blood Product Cost Burden in Patients Undergoing Cardiac Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-04 05:30:41","doi":"10.21203/rs.3.rs-5926543/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-27T13:27:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-16T15:58:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-06T04:53:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"244641503663510648570652855257368627639","date":"2025-06-02T04:28:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-31T17:24:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164547008456619304871607403332565678510","date":"2025-05-30T06:29:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"77712843613197333122189946288903659241","date":"2025-05-28T20:22:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-28T16:14:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-31T07:23:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-31T07:21:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2025-01-29T20:39:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c7bc248f-adba-4c93-b948-2d981e811b9c","owner":[],"postedDate":"February 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-01T06:23:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-04 05:30:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5926543","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5926543","identity":"rs-5926543","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}