Tuesday, October 25, 2016
Bayshore Ballroom ABC, Lobby Level (Westin Bayshore Vancouver)
Poster Board # PS 3-9

Ava John-Baptiste, PhD1, Yuan Qi, BSc2, Philip Jones, MD, MSc3, Davy Cheng, MD, MSc3 and Janet E. Martin, PharmD, MSc(HTA&M)1, (1)Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, ON, Canada, (2)Schulich School of Medicine and Dentistry, Western University, London, ON, Canada, (3)Department of Anesthesia & Perioperative Medicine, Western University, London, ON, Canada
Purpose: Hydroxyethyl starches (HES), in use for decades as fluid resuscitation therapy, have been shown to increase the risk of renal failure and transfusion in acutely ill patients in the intensive care unit. Use of HES in patients undergoing cardiac surgery remains standard of care in many institutions. The unit cost of HES is more than 20 times greater than that of crystalloids. Approximately, 1,300 patients per year undergo cardiac surgery at the London Health Sciences Centre (LHSC), in Ontario, Canada and these patients were exposed to HES through the cardiopulmonary bypass pump. LHSC considered the clinical and economic impact of disinvesting in HES in favour of using crystalloids exclusively for fluid resuscitation. Our objectives were to forecast the cost and clinical impact of disinvesting in HES and to estimate the value of conducting further research on this question rather than simply disinvesting.

Method:  We conducted a model-based cost-consequence analysis of the clinical and economic impact of disinvestment in HES, from the hospital perspective. We incorporated probabilities of clinical events from a previously conducted meta-analysis of RCTs, including transfusion, acute kidney injury, renal replacement therapy and mortality. We incorporated hospitalization costs and the cost of adverse events from Ontario hospital discharge abstract data. Unit costs of each therapy (HES, crystalloids) were obtained from hospital records. We ran 10,000 simulations in probabilistic sensitivity analysis, to estimate the probability that HES disinvestment would save costs. We used the simulation results to estimate the value of information. We multiplied the probability that disinvestment in HES is the wrong decision, by the magnitude of expected losses and the number of cardiac surgeries over a one-year time frame. All costs were expressed in 2014 Canadian Dollars. 

Result: The decision model forecasted that HES disinvestment would save costs with a median cost differenece of -$107.05 95%CrI (-$1289.81, $101.44). The probability that disinvestment in HES would increase rather than save costs was 21.2%, with an expected loss of $62.84 per hospitalization. Thus, the resulting VOI was $13.32 per patient, or $17,319.35. 

Conclusion: Our decision model forecasted that disinvestment in HES would save money. Given the lack of evidence indicating HES is safer than crystalloids and the high cost of research relative to the VOI, LHSC opted to disinvest in HES.