Data Stream
Reduce, Reuse, Recycle? The American Way
People undergoing heart surgery may have better outcomes
if they have their own blood “recycled” and re-infused
during the procedure, according to a study presented at the
Society of Thoracic Surgeons Annual Meeting. Establishing universal health coverage
is a global priority for the World Health
Organization, but U.S. health-care prices
are putting a damper on that dream, per
a review from the Institute for Health
Metrics and Evaluation.
Researchers reviewed transfusion outcomes from 689
patients – 268 who underwent surgery following typical
transfusion protocols and 420 who underwent surgery
following an autologous blood donation protocol.
Compared with those
treated with a typical
transfusion strategy,
patients who had
surgery with their
own “recycled” blood
reinfused had:
Looking at health-care
resource use and costs for 130
countries, the authors found
that the U.S. outranked every
country (except for Sweden),
with average costs of $478
for an outpatient visit and
$22,543 for an inpatient
admission.
“Not surprisingly, we found both [overuse and underuse] of services among inpatient and outpatient
facilities,” the authors wrote, noting that with its high resource use and costs, the U.S. falls into the
“overuse” category. “We identified countries like the Netherlands, Portugal, and Thailand that have the
right amount of each.”
Source: Moses MW, Pedroza P, Baral R, et al. Funding and services needed to achieve universal health coverage: applications of global,
regional, and national estimates of utilisation of outpatient visits and inpatient admissions from 1990 to 2016, and unit costs from 1995 to
2016. Lancet Pub Health. 2019;4:e49-73.
Keep an Open Mind
• fewer total
transfusions
(0.79 vs. 1.76)
• lower likelihood
of requiring
postoperative
transfusions
(70% vs. 40%)
• shorter length of stay
(6.8 days vs. 7.8 days)
Relaxing clinical trials exclusion criteria might help increase participation, as most oncologists don’t
discuss clinical trial participation if their patients have comorbidities.
Researchers asked 3,610 patients with comorbidities and 1,889 without comorbidities whether their
physicians had discussed clinical trials with them. Compared with those without comorbidities, fewer
patients with comorbidities:
were talked to about
clinical trials:
50%
40%
30%
20%
participated in
clinical trials:
10%
0%
Source: Zimmerman E, Avgerinos DV, Zhu R, Ogami T. Autologous blood
donation leads to better outcomes in cardiac surgery. Presented at the Society
of Thoracic Surgeons Annual Meeting; January 28, 2019; San Diego, CA.
The authors estimated that 6,317 additional patients could be registered every year if comorbid-
ity restrictions (like those concerning hepatic and renal function, cardiovascular disease, and previous
malignancy) were lifted.
Source: Unger JM, Hershman DL, Fleury ME, et al. Association of patient comorbid conditions with cancer clinical trial participation.
JAMA Oncol. 2019 January 10. [Epub ahead of print]
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ASH Clinical News
April 2019