Skip to main content

Advertisement

SpringerLink
Log in

Blood component use and associated costs after standard dose chemotherapy—a prospective analysis of routine hospital care in lymphoproliferative disorders and NSCLC in Germany

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to describe blood component (BC) use and respective cost after standard dose chemotherapy (CT) in routine hospital care.

Methods

Analysis of data from a prospective, multicenter, longitudinal, observational study on lymphoproliferative disorder (LPD) and non-small cell lung cancer (NSCLC) patients undergoing first or second line standard dose (immuno-)CT. Data were collected from patient interviews and pre-planned chart reviews. Costs of BC are presented from provider perspective.

Results

One hundred eighty patients (n = 85 NSCLC, n = 95 LPD) receiving 189 CT lines/633 CT cycles) were evaluable (mean ± SD age, 59 ± 13.2 years, 68% stage III/IV, 14% Eastern Cooperative Oncology Group ≥ 2). During 11% of cycles, BC were transfused to 27% of patients (n = 49; n = 22 NSCLC, n = 27 LPD). Of 310 transfused units (TU), 68% were red blood cells (RBC). Mean number of TU per cycle with transfusion was 3.3 ± 2.9 (median = 2, range = 2–17) for RBC, 4.8 ± 6.8 (median = 2, range = 1–23) for platelets (PLT) and 12.8 ± 14.6 (median = 8, range = 2–33) for fresh frozen plasma (FFP). Fifteen per cent of RBC units, 60% of PLT units and 92% of FFP in this study were transfused in cycles with sepsis. Mean BC cost per CT line were €602 ± 1,458 (median = 135, range = 135–9,385; NSCLC: €292 ± 376, median = 135, range = 135–2,124; LPD: €1,010 ± 2,137, median = 212, range = 135–9,385, p = 0.2137). For 55% of transfused RBC units, haemoglobin levels on the day of transfusion were 8.0–8.9 g/dl, for 38% <8 g/dl and for 7% ≥ 9 g/dl. Seventy-five per cent of PLT units were transfused at a PLT count <11,000/μl and 21% at 20,000–11,000/μl.

Conclusions

The results reflect the diversity of BC use after standard dose CT. High transfusion need is associated with infectious complications, i.e. sepsis emphasising the need for adequate prophylaxis and further knowledge of baseline risk factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Bohlius J, Schmidlin K, Brillant C, Schwarzer G, Trelle S, Seidenfeld J, Zwahlen M, Clarke MJ, Weingart O, Kluge S, Piper M, Napoli M, Rades D, Steensma D, Djulbegovic B, Fey MF, Ray-Coquard I, Moebus V, Thomas G, Untch M, Schumacher M, Egger M, Engert A (2009) Erythropoietin or Darbepoetin for patients with cancer—meta-analysis based on individual patient data. Cochrane Database Syst Rev (3):CD007303

  2. Bohlius J, Schmidlin K, Brillant C, Schwarzer G, Trelle S, Seidenfeld J, Zwahlen M, Clarke M, Weingart O, Kluge S, Piper M, Rades D, Steensma DP, Djulbegovic B, Fey MF, Ray-Coquard I, Machtay M, Moebus V, Thomas G, Untch M, Schumacher M, Egger M, Engert A (2009) Recombinant human erythropoiesis-stimulating agents and mortality in patients with cancer: a meta-analysis of randomised trials. Lancet 373(9674):1532–1542

    Article  PubMed  CAS  Google Scholar 

  3. Zimmermann R, Buscher M, Linhardt C, Handtrack D, Zingsem J, Weisbach V, Eckstein R (1997) A survey of blood component use in a German university hospital. Transfusion 37(10):1075–1083

    Article  PubMed  CAS  Google Scholar 

  4. Krebs in Deutschland 2003–2004. Häufigkeiten und Trends (2008). vol 6. überarbeitete und aktualisierte Auflage. Berlin

  5. Liou S (2007) Economic burden of haematological adverse effects in cancer patients: a systematic review. Clin Drug Investig 27(6):381–396

    Article  PubMed  CAS  Google Scholar 

  6. Cantor SB, Hudson DV Jr, Lichtiger B, Rubenstein EB (1998) Costs of blood transfusion: a process-flow analysis. J Clin Oncol 16(7):2364–2370

    PubMed  CAS  Google Scholar 

  7. Weimar C, Weber C, Wagner M, Busse O, Haberl RL, Lauterbach KW, Diener HC (2003) Management patterns and health care use after intracerebral hemorrhage—a cost-of-illness study from a societal perspective in Germany. Cerebrovasc Dis 15(1–2):29–36

    Article  PubMed  Google Scholar 

  8. Paessens B, von Schilling C, Ehlken B, Shlaen M, Berger K, Bernard R, Peschel C, Ihbe-Heffinger A (2008) Resource use and costs associated with routine management of chemotherapy related toxicity in german hospitals (abstract). Ann Oncol 19 (suppl 8):viii272. doi:10.1093/annonc/mdn524

  9. Paessens B, Schilling Cv, Berger K, Shlaen M, Müller-Thomas C, Bernard R, Peschel C, Ihbe-Heffinger A (2011) Health resource consumption and costs attributable to chemotherapy-induced toxicity in German routine hospital care in lymphoproliferative disorder and NSCLC patients. Ann Oncol. doi:10.1093/annonc/mdq759

  10. The Uppsala Monitoring Centre (2007) The use of the WHO-UMC system for standardised case causality assessment. Available at http://www.who-umc.org/graphics/4409.pdf. Accessed 3 December 2009

  11. National Cancer Institute (2006) Common terminology criteria for adverse events v3.0 (CTCAE). Available at http://ctep.cancer.gov/forms/CTCAEv3.pdf

  12. Querschnitts-Leitlinien (BÄK) zur Therapie mit Blutkomponenten und Plasmaderivaten (ed) (2008), vol 4. Auflage. Deutscher Ärzte-Verlag, Cologne

  13. The Sanguis Study Group (1994) Use of blood products for elective surgery in 43 European hospitals. Transfus Med 4(4):251–268

    Article  Google Scholar 

  14. Dranitsaris G (2000) The cost of blood transfusions in cancer patients: a reanalysis of a Canadian economic evaluation. J Oncol Pharm Pract 6:37–42

    Google Scholar 

  15. Cremieux PY, Barrett B, Anderson K, Slavin MB (2000) Cost of outpatient blood transfusion in cancer patients. J Clin Oncol 18(14):2755–2761

    PubMed  CAS  Google Scholar 

  16. Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E (1999) A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 340(6):409–417

    Article  PubMed  CAS  Google Scholar 

  17. Hill SR, Carless PA, Henry DA, Carson JL, Hebert PC, McClelland DB, Henderson KM (2010) Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev (10):CD002042

  18. Ludwig H, Van Belle S, Barrett-Lee P, Birgegard G, Bokemeyer C, Gascon P, Kosmidis P, Krzakowski M, Nortier J, Olmi P, Schneider M, Schrijvers D (2004) The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur J Cancer 40(15):2293–2306

    Article  PubMed  Google Scholar 

  19. Syrjala MT, Kytoniemi I, Mikkolainen K, Ranimo J, Lauharanta J (2001) Transfusion practice in Helsinki University Central Hospital: an analysis of diagnosis-related groups (DRG). Transfus Med 11(6):423–431

    Article  PubMed  CAS  Google Scholar 

  20. Meehan KR, Matias CO, Rathore SS, Sandler SG, Kallich J, LaBrecque J, Erder H, Schulman KA (2000) Platelet transfusions: utilization and associated costs in a tertiary care hospital. Am J Hematol 64(4):251–256

    Article  PubMed  CAS  Google Scholar 

  21. Riess H (1998) Hämostasestörungen im Umfeld von Sepsis und SIRS. Internist V39(5):479–484

    Article  Google Scholar 

  22. Slichter SJ (2004) Relationship between platelet count and bleeding risk in thrombocytopenic patients. Transfus Med Rev 18(3):153–167

    Article  PubMed  Google Scholar 

  23. Stanworth SJ, Hyde C, Heddle N, Rebulla P, Brunskill S, Murphy MF (2004) Prophylactic platelet transfusion for haemorrhage after chemotherapy and stem cell transplantation. Cochrane Database Syst Rev (4):CD004269

  24. Agrawal S, Davidson N, Walker M, Gibson S, Lim C, Morgan CL, Cowell W (2006) Assessing the total costs of blood delivery to hospital oncology and haematology patients. Curr Med Res Opin 22(10):1903–1909. doi:10.1185/030079906X132532

    Article  PubMed  Google Scholar 

  25. Brilhante D, Macedo A, Santos A (2008) Estimating the microcosts of blood transfusion for hemato-oncological patients. Acta Méd Port 21(6):575–580

    PubMed  Google Scholar 

  26. Elting LS, Cantor SB, Martin CG, Hamblin L, Kurtin D, Rivera E, Vadhan-Raj S, Benjamin RS (2003) Cost of chemotherapy-induced thrombocytopenia among patients with lymphoma or solid tumors. Cancer 97(6):1541–1550

    Article  PubMed  Google Scholar 

  27. Ackerman SJ, Klumpp TR, Guzman GI, Herman JH, Gaughan JP, Bleecker GC, Mangan KF (2000) Economic consequences of alterations in platelet transfusion dose: analysis of a prospective, randomized, double-blind trial. Transfusion 40(12):1457–1462. doi:10.1046/j.1537-2995.2000.40121457.x

    Article  PubMed  CAS  Google Scholar 

  28. Snider C, Erder H, LaBrecque J (1996) What are the true costs of platelet transfusions? A prospective time motion study of resource utilization associated with platelet transfusions at UCLA Medical Center. Blood 88:333a (abstract)

    Google Scholar 

  29. Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH (2006) Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer 106(10):2258–2266

    Article  PubMed  Google Scholar 

  30. Strauss RG (2001) Economy of platelet transfusions from a hospital perspective: pricing predicates practice. Transfusion 41(12):1617–1624

    Article  PubMed  CAS  Google Scholar 

  31. Stover EP, Siegel LC, Parks R, Levin J, Body SC, Maddi R, D'Ambra MN, Mangano DT, Spiess BD (1998) Variability in transfusion practice for coronary artery bypass surgery persists despite national consensus guidelines: a 24-institution study. Institutions of the Multicenter Study of Perioperative Ischemia Research Group. Anesthesiology 88(2):327–333

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgement

This investigator-initiated study was supported by the Lilly Deutschland GmbH, Bad Homburg, Germany, and the Amgen GmbH, Munich, Germany. The study sponsors were not involved in the study design, data collection, in the analysis and interpretation of data, in the writing of the manuscript and in the decision to submit the manuscript for publication.

Conflict of interest

Bernadette Paessens, Wolfgang Schramm, Karin Berger, Christoph von Schilling, Rudolf Bernard have no conflict of interest. Angela Ihbe-Heffinger received a research grant (Lilly, Amgen), honoraria (Amgen).

Author information

Authors and Affiliations

  1. Krankenhausapotheke, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Bernadette Paessens & Rudolf Bernard

  2. Krankenhausapotheke, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaninger Strasse 22, 81675, Munich, Germany

    Bernadette Paessens

  3. Frauenklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Angela Ihbe-Heffinger

  4. Innere Medizin III, Klinikum Freising, Munich, Germany

    Christoph von Schilling

  5. IMS Health Economics and Outcomes Research, IMS Health, Munich, Germany

    Rita Shlaen

  6. III. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Christian Peschel

  7. Abteilung für Transfusionsmedizin und Haemostaseologie, Klinikum der Universität München, Munich, Germany

    Wolfgang Schramm & Karin Berger

Authors
  1. Bernadette Paessens
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Angela Ihbe-Heffinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christoph von Schilling
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rita Shlaen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rudolf Bernard
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christian Peschel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wolfgang Schramm
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Karin Berger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bernadette Paessens.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Paessens, B., Ihbe-Heffinger, A., von Schilling, C. et al. Blood component use and associated costs after standard dose chemotherapy—a prospective analysis of routine hospital care in lymphoproliferative disorders and NSCLC in Germany. Support Care Cancer 20, 1011–1021 (2012). https://doi.org/10.1007/s00520-011-1173-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-011-1173-1

Keywords

Search

Navigation