Blood Inflation
Karen L. Dallas, M.D.C.M.
TMR Journal Club
May 4, 2010
“Activity-Based Costs of Blood
Transfusions in Surgical
Patients at Four Hospitals”
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Transfusion April 2010. Vol 50(4), 753-765.
About me…
American (from Minnesota!)
McGill Medical School
U of T – Hematopathology Residency
BloodCenter of Wisconsin Fellowship in
Transfusion/Coagulation + Research
…then back to Canada! 
Objectives
Why this article?
Relevant background information
Article Review
Critical Appraisal
Discussion
(the “meat & potatoes” of this JC!)
Why? (at least some of it!)
>14 million units collected annually in US
>1 million in Canada
Previous cost estimates ~$300-700 US
Studies/methods imperfect at best
Economic decision-making is increasingly
important
Canadian Situation
1994 – Mean cost per unit RBC transfused in
Canada was reported at $152.17 US
CBS/HQ paper (Transfusion, 2004) re-visited
issue:
 Total $264.81 US
Collection, production, distribution = $202.74
Donor time = $18.21
Hospital processing = $16.65
Actual transfusion = $26.92
Acute reaction management = $0.29
Accounting 101
Costing a.k.a. Cost Accounting
type of accounting process which aims to
capture costs of production
most beneficial as a tool for management in
budgeting and setting up cost control programs
Traditional Costing
VS.
Activity-Based Costing (ABC)
Entire 136-page OCCI Guide…
0 entries for transfusion or blood!!
Methods
Main Processes in Transfusion Chain
Flow Diagram
(YIKES!)
Formulas… (YIKES!)
Costs of Acquisition and Costs per Unit
Are the results valid?
In this case, I think we can safely say, “Yes!”
What are the results?
These results show the cost of blood – in US and
European settings alike – to be much higher than
previously reported. They also demonstrate the
amount of “overhead”cost inherent to hemotherapy.
How can we apply the results to patient care?
This is the subject of our discussion…
Discussion
A few starter questions…
Is ABC worthwhile?
 Idea of LEAN Accounting…
Should we re-visit the cost of Blood Center
Production?
What are we to do with this information?
Blood conservation, blood alternatives, etc.
Transfusion is life-saving…are all “costs”
created equally?
Thank-you!
Dr. Skeate
and
CBS Medical Office, Toronto
Dr. Fernandes, U of T Hematopathology