Global implementation of PBM is highly relevant due to limited healthcare resources and donor blood shortages as a result of the pandemic, and is recommended by various institutions such as the WHO and ECDC.1–3
PBM is associated with significantly improved patient outcomes*4–8 and reduced blood utilisation4–11 across large observational studies, randomised controlled trials and meta-analyses.
weight of evidence for PBM
Drabinski T et al. 2020 Evidence-based health economic model†12
Trentino KM et al. 2020 Retrospective cohort study‡13
Wan S et al. 2020 Retrospective cohort study§14
Kaserer A et al. 2019 Retrospective cohort study¶15
Data from individual studies cannot be directly compared due to differences in methodologies. Please see the full publications for further details.
CSL Vifor is a global leader in iron deficiency and anaemia management; a key component in PBM. For more than a decade we have partnered with international societies and hospitals to speed up the implementation of PBM across the world.
*A retrospective, observational study of patients admitted to four major tertiary-care centres in Western Australia between 2008 and 2014 (n=605,046), to assess the impact of the PBM program on key outcome measures. The study found that when comparing final year to baseline there was a statistically significant 41% reduction in units of RBC, FFP and platelets transfused. In activity-based cost savings, this was estimated to the value of between AU$80 and AU$100. There were also statistically significant reductions in: anaemic elective surgery admissions (20.8%–14.4%); mean pre-transfusion Hb levels (7.9–7.3g/dL); hospital mortality (OR, 0.72); hospital acquired infections (OR, 0.79); length of stay (IRR, 0.85); and acute myocardial infarction-stroke (OR, 0.69). There were statistically significant increases in the numbers of single-unit RBC transfusions (from 33.3–63.7%) and all-cause emergency readmissions (OR, 1.06). See Leahy MF et al. for full study details in reference list below.4
†A health economic study (n=4,591,060) using representative secondary data from the German database DRG Statistic for 2015, to quantify the potential epidemiological and health economic benefits of implementing PAMs in clinical practice within the German healthcare system. The study predicted that implementing PAMs would result in: a decrease in total hospital days, from 29,370,510 to 28,774,440; a decrease in the total number of patients receiving an RBC transfusion, from 227,180 to 194,986; and cost savings per patient by €226 (€536,260,658 direct costs + €503,082,907 costs of avoidable hospital days = €1,039,343,565 total hospital costs associated with implementing PAMs. Cost saving per patient = €1,039,343,565/4,591,060 = €226.38). See Drabinski T et al. for full study details in reference list below.12
‡A cost effectiveness analysis study (n=680) using outcome data from a retrospective cohort study, comparing elective colorectal surgery patients admitted between 2015 and 2019 pre- and post-implementation of a PBM clinic at Fiona Stanley Hospital, Australia. The study found that pre-operative screening and treatment for anaemia resulted in: a decrease in length of stay, from 8.4 days to 7.4 days (P=0.011); a numerical decrease in patients who received an RBC transfusion, from 8.8% to 5.9% (P=0.207); and a reported mean difference in total (screening, treatment and hospitalisation) costs of €2325 (P<0.001). See Trentino KM et al. for full study details in reference list below.13
§A retrospective, observational study evaluating the prevalence of POA and its independent effects on ABT, LOS, complications, mortality and costs (n=828) in patients undergoing major orthopaedic surgery between 2016 and 2018 at Karolinska University Hospital, Sweden. The study indicated that pre-operative screening and treatment for anaemia would result in: a decrease in length of stay, from 4.4 days to 3.1 days (P<0.001); a decrease in patients requiring allogeneic blood transfusion, from 61.4% to 14.7% (P<0.001); and reported potential savings of €254 per patient, based on short-term outcomes and costs (including screening tests for iron deficiency, one 1000 mg dose of intravenous iron treatment, transfusion and hospital days). See Wan S et al. for full study details in reference list below.14
¶A retrospective impact study (n=213,882) assessing the implementation of a hospital-wide PBM monitoring and feedback programme at University Hospital of Zurich, from January 2012 to December 2017. The study found that introducing a PBM monitoring and feedback programme resulted in: a reduction in length of stay over the study period, from 7.02 days to 7.0 days (P<0.001); a decrease in patients transfused, from 8.5% to 6.7% (P<0.001); and savings associated with allogeneic blood products (red blood cells, platelets, fresh frozen plasma) of CHF 3,015,690 in 2015, CHF 3,357,779 in 2016 and CHF 3,660,086 in 2017, resulting in total savings over the 3-year sustainability period of CHF 10,033,555. Cost saving per patient (n=111,914) = €82.98 (CHF 10,033,555/111,914 = CHF 82.65 = €82.98) See Kaserer A et al. for full study details in reference list below.15
#A gross savings estimation, when blood product cost and hospital costs of administering a transfusion are combined. See Leahy MF et al. for full study details in reference list below.4
ABT, allogeneic blood transfusion; DRG, Diagnosis-Related Groups; ECDC, European Centre for Disease Prevention and Control; FFP, fresh frozen plasma; Hb, haemoglobin; IRR, incidence rate ratio; LOS, length of stay; OR, odds ratio; PAMs, pre-operative anaemia measures; PBM, patient blood management; POA, pre-operative anaemia; RBC, red blood cell; WHO, World Health Organization.
- Shander A et al. Anesth Analg. 2020;131(1):75–85.
- WHO interim guidance: Maintaining a safe and adequate blood supply during the pandemic outbreak of coronavirus disease (COVID-19), March 2020.
- ECDC rapid risk assessment: Novel coronavirus disease 2019 (COVID-19) pandemic: increased transmission in the EU/EEA and the UK – sixth update, March 2020.
- Leahy MF et al. Transfusion. 2017;57(6):1347–58.
- Keding V et al. World J Surg Oncol. 2018;16:159.
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- Drabinski T et al. Adv Ther. 2020;37:3515–36.
- Trentino KM et al. Anaesthesia. 2021;76(3):357–65.
- Wan S et al. J Arthroplasty. 2020;35:3084–88.
- Kaserer A et al. Anaesthesia. 2019;74(12):1534–41.
- World Health Organization. 2021. The urgent need to implement patient blood management: policy brief. https://apps.who.int/iris/handle/10665/346655 (last accessed January 2023).
- Vos T et al. Lancet. 2016;388:1545–602.
- Vos T et al. Lancet. 2017;390:1211–59.
- Kassebaum NJ et al. Hematol Oncol Clin North Am. 2016;30:247–308.
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- Weber CF et al. Anesthesiology. 2012;117:531–47.
- Frank SM et al. Anesthesiology. 2017;127:754–64.
- Bolcato M et al. Transfus Apher Sci. 2020:102779.