(P-PB-28) The Business Case for Cryo in a Children’s Hospital

INTERCEPT® Fibrinogen Concentrate (IFC) is indicated for treatment and control of bleeding associated with fibrinogen deficiency and has a five-day shelf-life post-thaw, conferring logistic advantages over Cryoprecipitated Anti-Hemophilic Factor (cryo).  However, the cost of IFC is generally higher than that of cryo.  We performed a cost-benefit analysis to determine whether IFC would be beneficial in reducing our cryo wastage, and whether the wastage reduction would confer a cost savings.

Study

Design/Methods:

All cryo orders at a single pediatric level one trauma center were analyzed for the calendar year 2023.  Acquisition costs and wastage rates were calculated based on product disposition.  Usage data was analyzed to determine whether wasted products could have been re-issued based on 5d vs 4h (for pools) or 6h (for single units) outdate and on ABO type.  Because of a risk of hemolysis, institutional practice is to provide ABO compatible cryo to patients less than 40kg, but of any ABO type for patients 40kg or greater.  Estimates of acquisition and wastage costs for IFC were calculated based on reduced wastage due to predicted re-issue of 5d products.

Results/Findings:

In total 302 orders for cryo were submitted by clinicians (283 single units, 19 pools).   Of those, 247 were presumed transfused, 4 were quarantined, and 51 were discarded (17.1% discard rate overall; 16.3% discard rate for single units; 26.3% discard rate for pools).  Of the products discarded, 19 could have been reallocated to subsequent orders if IFC had been used instead of cryo (37.3% reduction in discard, reallocating 18 single units and 1 pool).  Reasons for low reallocation rates are shown in the figure.  Cost of wasted products totaled approximately $5700, of which $1800 could be avoided with IFC.  However, replacing all cryo inventory with IFC would result in a 640% increase in acquisition cost and a 397% increase in the cost of wastage, despite the lower rate of wastage.

Conclusions:

While an increase in shelf life may have significant benefits for some transfusion services, replacing cryo with IFC would result in significant cost increases (for acquisition and wastage) with only modest absolute waste reduction in our facility.  Because wastage potential of a given unit of cryo cannot be determined prior to issue, a mixed inventory would confer little benefit.  Additionally, the increased volume of IFC units may be undesirable for patients requiring less than one pool (1 unit of cryo = 20mL; FC10 IFC = 81mL).  Unless the cost of IFC can be reduced, the benefits of a total IFC inventory are unlikely to outweigh the costs in our center.