Comparison of blood product use and costs with use of 3-factor versus 4-factor prothrombin complex concentrate for off-label indications

Jessica DeAngelo, Daniel H. Jarrell, Richard Cosgrove, James Camamo, Christopher J. Edwards, Asad E Patanwala

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose. Results of a comparison of blood product use and cost outcomes with use of 3-factor versus 4-factor prothrombin complex concentrate (PCC) for indications other than warfarin reversal are presented. Methods. Consecutive patients who received 3-factor PPC (PCC3) or 4-factor PCC (PCC4) for non–warfarin-related indications at 2 U.S. hospitals during a 19-month period were identified. The primary outcome was in-hospital blood product use, with a focus on plasma use. Total hemostasis costs, intensive care unit (ICU) and hospital lengths of stay, and other outcomes were evaluated. Results. Indications for PCC3 use (n = 118) or PCC4 use (n = 64) included intraoperative bleeding, nonintraoperative bleeding, coagulopathy of liver disease, and reversal of direct-acting oral anticoagulant effects. The proportion of patients who received plasma was 56.8% with PCC3 use versus 53.1% with PCC4 use (p = 0.643); the corresponding median volumes of plasma received were 638 mL (interquartile range [IQR], 550–1,355 mL) and 656 mL (IQR, 532–1,136 mL), respectively. The median total hemostasis costs were $5,559 (IQR, $3,922–$8,159) with PCC3 use and $7,771 (IQR, $6,366–$9,205) with PCC4 use (p < 0.001). Conclusion. PCC3 use and PCC4 use were associated with similar blood product use, ICU length of stay, hospital length of stay, and in-hospital mortality when given for non–warfarin-related indications. However, relative to PCC3 use, PCC4 use was associated with an increase in costs that was primarily due to drug costs.

Original languageEnglish (US)
Pages (from-to)1103-1109
Number of pages7
JournalAmerican Journal of Health-System Pharmacy
Volume75
Issue number15
DOIs
StatePublished - Aug 1 2018

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Length of Stay
Costs and Cost Analysis
Hemostasis
Intensive Care Units
Hemorrhage
Drug Costs
Plasma Volume
Warfarin
Hospital Mortality
Anticoagulants
Liver Diseases
prothrombin complex concentrates

Keywords

  • Anticoagulants
  • Blood coagulation disorders
  • Blood coagulation factors
  • Hemorrhage
  • Injuries
  • Wounds

ASJC Scopus subject areas

  • Pharmacology
  • Health Policy

Cite this

Comparison of blood product use and costs with use of 3-factor versus 4-factor prothrombin complex concentrate for off-label indications. / DeAngelo, Jessica; Jarrell, Daniel H.; Cosgrove, Richard; Camamo, James; Edwards, Christopher J.; Patanwala, Asad E.

In: American Journal of Health-System Pharmacy, Vol. 75, No. 15, 01.08.2018, p. 1103-1109.

Research output: Contribution to journalArticle

DeAngelo, Jessica ; Jarrell, Daniel H. ; Cosgrove, Richard ; Camamo, James ; Edwards, Christopher J. ; Patanwala, Asad E. / Comparison of blood product use and costs with use of 3-factor versus 4-factor prothrombin complex concentrate for off-label indications. In: American Journal of Health-System Pharmacy. 2018 ; Vol. 75, No. 15. pp. 1103-1109.
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abstract = "Purpose. Results of a comparison of blood product use and cost outcomes with use of 3-factor versus 4-factor prothrombin complex concentrate (PCC) for indications other than warfarin reversal are presented. Methods. Consecutive patients who received 3-factor PPC (PCC3) or 4-factor PCC (PCC4) for non–warfarin-related indications at 2 U.S. hospitals during a 19-month period were identified. The primary outcome was in-hospital blood product use, with a focus on plasma use. Total hemostasis costs, intensive care unit (ICU) and hospital lengths of stay, and other outcomes were evaluated. Results. Indications for PCC3 use (n = 118) or PCC4 use (n = 64) included intraoperative bleeding, nonintraoperative bleeding, coagulopathy of liver disease, and reversal of direct-acting oral anticoagulant effects. The proportion of patients who received plasma was 56.8{\%} with PCC3 use versus 53.1{\%} with PCC4 use (p = 0.643); the corresponding median volumes of plasma received were 638 mL (interquartile range [IQR], 550–1,355 mL) and 656 mL (IQR, 532–1,136 mL), respectively. The median total hemostasis costs were $5,559 (IQR, $3,922–$8,159) with PCC3 use and $7,771 (IQR, $6,366–$9,205) with PCC4 use (p < 0.001). Conclusion. PCC3 use and PCC4 use were associated with similar blood product use, ICU length of stay, hospital length of stay, and in-hospital mortality when given for non–warfarin-related indications. However, relative to PCC3 use, PCC4 use was associated with an increase in costs that was primarily due to drug costs.",
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AU - Camamo, James

AU - Edwards, Christopher J.

AU - Patanwala, Asad E

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N2 - Purpose. Results of a comparison of blood product use and cost outcomes with use of 3-factor versus 4-factor prothrombin complex concentrate (PCC) for indications other than warfarin reversal are presented. Methods. Consecutive patients who received 3-factor PPC (PCC3) or 4-factor PCC (PCC4) for non–warfarin-related indications at 2 U.S. hospitals during a 19-month period were identified. The primary outcome was in-hospital blood product use, with a focus on plasma use. Total hemostasis costs, intensive care unit (ICU) and hospital lengths of stay, and other outcomes were evaluated. Results. Indications for PCC3 use (n = 118) or PCC4 use (n = 64) included intraoperative bleeding, nonintraoperative bleeding, coagulopathy of liver disease, and reversal of direct-acting oral anticoagulant effects. The proportion of patients who received plasma was 56.8% with PCC3 use versus 53.1% with PCC4 use (p = 0.643); the corresponding median volumes of plasma received were 638 mL (interquartile range [IQR], 550–1,355 mL) and 656 mL (IQR, 532–1,136 mL), respectively. The median total hemostasis costs were $5,559 (IQR, $3,922–$8,159) with PCC3 use and $7,771 (IQR, $6,366–$9,205) with PCC4 use (p < 0.001). Conclusion. PCC3 use and PCC4 use were associated with similar blood product use, ICU length of stay, hospital length of stay, and in-hospital mortality when given for non–warfarin-related indications. However, relative to PCC3 use, PCC4 use was associated with an increase in costs that was primarily due to drug costs.

AB - Purpose. Results of a comparison of blood product use and cost outcomes with use of 3-factor versus 4-factor prothrombin complex concentrate (PCC) for indications other than warfarin reversal are presented. Methods. Consecutive patients who received 3-factor PPC (PCC3) or 4-factor PCC (PCC4) for non–warfarin-related indications at 2 U.S. hospitals during a 19-month period were identified. The primary outcome was in-hospital blood product use, with a focus on plasma use. Total hemostasis costs, intensive care unit (ICU) and hospital lengths of stay, and other outcomes were evaluated. Results. Indications for PCC3 use (n = 118) or PCC4 use (n = 64) included intraoperative bleeding, nonintraoperative bleeding, coagulopathy of liver disease, and reversal of direct-acting oral anticoagulant effects. The proportion of patients who received plasma was 56.8% with PCC3 use versus 53.1% with PCC4 use (p = 0.643); the corresponding median volumes of plasma received were 638 mL (interquartile range [IQR], 550–1,355 mL) and 656 mL (IQR, 532–1,136 mL), respectively. The median total hemostasis costs were $5,559 (IQR, $3,922–$8,159) with PCC3 use and $7,771 (IQR, $6,366–$9,205) with PCC4 use (p < 0.001). Conclusion. PCC3 use and PCC4 use were associated with similar blood product use, ICU length of stay, hospital length of stay, and in-hospital mortality when given for non–warfarin-related indications. However, relative to PCC3 use, PCC4 use was associated with an increase in costs that was primarily due to drug costs.

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KW - Blood coagulation factors

KW - Hemorrhage

KW - Injuries

KW - Wounds

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