Cost-minimization analysis of two fluid products for resuscitation of critically injured trauma patients.

Abstract

PURPOSE:

Results of a study to determine potential cost benefits of substituting an alternative electrolyte solution for 0.9% sodium chloride injection for the initial fluid resuscitation of trauma patients are presented.

METHODS:

Using data from a randomized clinical trial that compared 24-hour fluid resuscitation outcomes in critically injured trauma patients treated with 0.9% sodium chloride injection and those who received a balanced electrolyte solution (Plasma-Lyte A, Baxter Healthcare), a cost-minimization analysis was performed at a large medical center. The outcomes evaluated included fluid and drug acquisition costs, materials and nurse labor costs, and costs associated with electrolyte replacement.

RESULTS:

The use of Plasma-Lyte A was associated with a relatively higher fluid acquisition cost but a reduced need for magnesium replacement. During the first 24 hours of hospitalization, 4 of 24 patients (17%) treated with 0.9% sodium chloride injection and none of the patients who received the comparator product (n = 22) required supplemental magnesium. Patients treated with 0.9% sodium chloride injection received a median of 4 g of magnesium (interquartile range [IQR], 2.5-4.0 g), compared with a median of 0 g (IQR 0-2 g) in the comparator group. Taking into account the costs of consumable supplies and nursing labor, the cost-minimization analysis indicated a 24-hour cost differential of $12.35 in favor of Plasma-Lyte A.

CONCLUSION:

Substitution of Plasma-Lyte A for 0.9% sodium chloride injection for fluid resuscitation during the first 24 hours after traumatic injury was associated with decreased magnesium replacement requirements and a net cost benefit to the institution.

• Authors: Caitlin A Smith, Jeremiah J Duby, Garth H Utter, Joseph M Galante, Lynette A Scherer, Carol R Schermer
• Journal: American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists (Am J Health Syst Pharm) Vol. 71 Issue 6 Pg. 470-5 (Mar 15 2014) ISSN: 1535-2900 [Electronic] England
• PMID: 24589538 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Electrolytes
• Plasma Substitutes
• Saline Solution, Hypertonic
• Plasmalyte A

Topics

• Adult
• Cost-Benefit Analysis
• Critical Illness (economics, therapy)
• Double-Blind Method
• Electrolytes (administration & dosage, economics)
• Female
• Fluid Therapy (economics, methods)
• Humans
• Male
• Middle Aged
• Plasma Substitutes (administration & dosage, economics)
• Resuscitation (economics, methods)
• Saline Solution, Hypertonic
• Wounds and Injuries (economics, therapy)
• Young Adult