Economic evaluation of high-dose and low-dose aprotinin therapy during cardiopulmonary bypass

Background. Aprotinin therapy is now widely used during cardiac surgery. Th is study examined the clinical and economic effectiveness of high-dose or l ow-dose aprotinin in comparison to placebo. Methods. In a double blind, randomized study, three groups of 50 patients r eceived high-dose aprotinin costing AUS$614 per patient (AUS$ = Australian dollars), low-dose aprotinin costing AUS$220 per patient or placebo. Resour ce use influenced by aprotinin therapy was measured. Results. Both doses were effective in reducing chest drainage and postopera tive transfusion requirements, high-dose being more effective than low-dose . Both doses reduced the rate of reoperations for hemostasis. A base case o f statistically significant differences associated with the high-dose and l ow-dose aprotinin showed cost savings of AUS$77 and AUS$348 per patient, re spectively. If the demonstrated less significant reductions in operating ro om and ward stay are included, these savings become AUS$463 and AUS$715, re spectively. Alternately, if cross-matches are replaced by group-and-hold an d cell savers are not used, the savings per patient would be AUS$196 and AU S$467, respectively. Conclusions. While high-dose aprotinin is clinically more effective than lo w-dose aprotinin, low-dose therapy demonstrates greater cost savings. (Ann Thorac Surg 1999;68:940-5) (C) 1999 by The Society of Thoracic Surgeons.