From the 2023 HVPA National Conference
Ananda Thomas BA (Johns Hopkins School of Medicine), Janet Adegboye MD, Una Choi BA, Nadia Hensley MD, Elizabeth Crowe MD, PhD, Steve Frank MD
Over the past ten years, we established a comprehensive patient blood management program that includes both the Patient Blood Management Clinical Community and the Center for Bloodless Medicine and Surgery. The former aims to reduce unnecessary transfusions, and the latter is designed to avoid transfusions for patients who decline them. Here we report the overall return on investment for these programs along with patient outcomes.
After drafting formal business plans, support was obtained from the hospital administration to launch two programs – one to reduce unnecessary transfusions by implementing state-of-the-art patient blood management (PBM) methods across a large health system, and the other to care for patients who decline allogeneic transfusions for personal or religious reasons. Each program included multidisciplinary teams with salary support for key stakeholders. We have previously described in detail the methods of blood conservation we employ, and how these two programs operate using many of the same principles. Dashboards with financial analyses are reported at regular and frequent intervals to track the return on investment (ROI) for saving blood and money. Blood acquisition cost, not the fully loaded cost of blood with overhead was used to measure cost savings and the ROI. All major blood components were included. For incremental hospital revenue derived from Bloodless patients, the variable net margin (with direct cost of care subtracted) was used to calculate the ROI.
Over the ten-year period, the PBM Clinical Community reported an annual blood acquisition cost reduction of $2.9 million; from approximately $27 to $24 million dollars, representing a 10.9% decrease and a 9.6-fold ROI (Figure 1A). The Bloodless program brings in approximately $12 million yearly in net revenue, with $5 million yearly in variable net margin, representing a 6.6-fold ROI (Figure 1B). The overall ROI for both programs combined was 7.5. Clinical outcomes were unchanged in both programs (Figures 1C and 1D), although the incidence of hospital-acquired infections was significantly lower in the Bloodless patients compared to standard care patients accepting transfusions (Figure 1D). One caveat to consider is the recent switch to pathogen reduced platelets (in 2021) to satisfy FDA regulations, resulting in a 20% increase in platelet acquisition cost. Without this increase of $2 million dollars/year the ROI for the PBM program would have been 16.8-fold, and the ROI for the comprehensive blood management program (including the Bloodless program) would have been 9.5-fold.
The overall ROI for a comprehensive PBM program was 7.5, meaning that for every dollar invested, more than 7 dollars were either saved or generated in return. Given that clinical outcomes were either the same or better, PBM, including a Bloodless program, represents high value care with improved outcomes at lower cost.