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Taylor C, Yang L, Finfer S, Machado FR, YouZhong A, Billot L, Bloos F, Bozza F, Cavalcanti AB, Correa M, Du B, Hjortrup PB, McIntyre L, Saxena M, Schortgen F, Watts NR, Myburgh J, Thompson K, Hammond NE. An international comparison of the cost of fluid resuscitation therapies. Aust Crit Care 2020; 34:23-32. [PMID: 32828672 DOI: 10.1016/j.aucc.2020.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Fluid resuscitation is a ubiquitous intervention in the management of patients treated in the intensive care unit, which has implications for intensive care unit resourcing and budgets. Our objective was to calculate the relative cost of resuscitation fluids in several countries to inform future economic evaluations. METHODS We collected site-level data regarding the availability and cost of fluids as part of an international survey. We normalised costs to net present values using purchasing power parities and published inflation figures. Costs were also adjusted for equi-effective dosing based on intravascular volume expansion effectiveness and expressed as US dollars (USD) per 100 mL crystalloid equivalent. RESULTS A total of 187 sites had access to cost data. Between countries, there was an approximate six fold variation in the cost of crystalloids and colloids overall. The average cost for crystalloids overall was less than 1 USD per 100 mL. In contrast, colloid fluids had higher average costs (59 USD per 100 mL). After adjusting for equi-effective dosing, saline was ∼27 times less costly than albumin (saline: 0.6 USD per 100 mL crystalloid equivalent; albumin 4-5%: 16.4 USD; albumin 20-25%: 15.8 USD) and ∼4 times less costly than hydroxyethyl starch solution (saline: 0.6 USD; hydroxyethyl starch solution: 2.5 USD). Buffered salt solutions, such as compound sodium acetate solutions (e.g., Plasmalyte®), had the highest average cost of crystalloid fluids, costing between 3 and 4 USD per 100 mL. CONCLUSION The cost of fluid varies substantially between fluid types and between countries, although normal (0.9%) saline is consistently less costly than colloid preparations and some buffered salt solutions. These data can be used to inform future economic evaluations of fluid preparations.
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Affiliation(s)
- Colman Taylor
- Critical Care Division, The George Institute for Global Health, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia.
| | - Li Yang
- Critical Care Division, The George Institute for Global Health, Sydney, Australia
| | - Simon Finfer
- Critical Care Division, The George Institute for Global Health, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia; Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Flavia R Machado
- Anesthesiology, Pain and Intensive Care Department, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - An YouZhong
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Laurent Billot
- Faculty of Medicine, University of New South Wales, Sydney, Australia; Statistics Division, The George Institute for Global Health, Sydney, Australia
| | - Frank Bloos
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Fernando Bozza
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | | | - Maryam Correa
- Critical Care Division, The George Institute for Global Health, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Bin Du
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China
| | - Peter B Hjortrup
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Lauralyn McIntyre
- Department of Medicine (Critical Care), The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Manoj Saxena
- Critical Care Division, The George Institute for Global Health, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Intensive Care, Bankstown Hospital, Bankstown, Australia
| | - Frédérique Schortgen
- Assistance Publique-Hôpitaux de Paris, Réanimation Médicale Groupe Hospitalier Henri Mondor, Créteil, France
| | - Nicola R Watts
- Critical Care Division, The George Institute for Global Health, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - John Myburgh
- Critical Care Division, The George Institute for Global Health, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Intensive Care Medicine, St. George Hospital, Kograh, Australia
| | - Kelly Thompson
- Critical Care Division, The George Institute for Global Health, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Naomi E Hammond
- Critical Care Division, The George Institute for Global Health, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia.
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