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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2001 June;67(6):457-65

language: Italian

Plasma substitutes: strategies for use in intensive therapy to maintain a correct ratio between therapeutic efficacy and costs

Piacevoli Q., Caccamo F. *

ACO San Filippo Neri - Roma
*Università degli Studi «La Sapienza» - Roma


Background. The ­coice of one prod­uct rath­er ­than ­another in clin­i­cal prac­tice is ­based on two ­main cri­te­ria: ther­a­peu­tic effi­ca­cy and the ­cost of the prod­uct in ques­tion. However, if ther­a­peu­tic effi­ca­cy is ­equal, the ­choice of a ­less expen­sive prod­uct is not nec­es­sar­i­ly the ­right ­option. We com­pared the ­costs and ther­a­peu­tic effi­ca­cy of two prod­ucts ­used in plas­ma replace­ment ther­a­py in ­order to iden­ti­fy ­which ­would be the ­most advan­ta­geous.
Methods. A ­total of 126 ­patients due to under­go ­major abdom­i­nal sur­gery ­were recruit­ed and, hav­ing ­been ­duly ­informed, ­they ­were divid­ed ­into two ran­dom ­groups. One ­group was treat­ed ­with a solu­tion of hydrox­ye­thy­la­mide 6% ­with an inter­me­di­ate molec­u­lar ­weight (MW 200 kDa SD 0.5), and the oth­er was treat­ed ­with a solu­tion of mod­i­fied ­fluid gel­a­tine (MFG) at 4% (MW 30 kDa). The solu­tions ­were admin­is­tered to ­patients at the ­start of sur­gery ­until the morn­ing of the ­first post­op­er­a­tive day in ­order to main­tain ­mean arte­ri­al pres­sure (MAP) great­er ­than 60 mmHg and cen­tral ­venous pres­sure (CVP) ­between 10 and 14 mmHg. Moreover, the ­costs of the two prod­ucts and ­their addi­tion­al charg­es ­were tak­en ­into con­sid­er­a­tion, tak­en ­from the sup­ply ­lists pro­vid­ed by the phar­ma­cy in the hos­pi­tal ­where the ­study was car­ried out.
Results. No sig­nif­i­cant dif­fer­enc­es ­were ­found ­between the two ­groups in ­terms of ther­a­peu­tic effi­ca­cy. In eco­nom­ic ­terms, the ­cost of the ­entire infu­sion treat­ment was com­par­able ­between the two ­groups in ­spite of the high­er ­cost of hydrox­ye­thy­la­mide.
Conclusions. The high­er ­cost of hydrox­ye­thy­la­mide was com­pen­sat­ed by the ­fact ­that a small­er ­amount of the solu­tion is ­required to ­obtain the ­same hemo­dy­nam­ic param­e­ters guar­an­teed by gel­a­tine. Moreover, no ­adverse reac­tions ­were report­ed in ­this ­study to ­either com­pound. In the inter­na­tion­al lit­er­a­ture, gel­a­tine is asso­ciat­ed ­with ­adverse reac­tions in a great­er num­ber of cas­es ­than hydrox­ye­thy­la­mide. This ­study ­shows ­that ­when pro­pos­ing strat­e­gies of use, a sim­ple ­cost anal­y­sis of the prod­ucts ­used is not suf­fi­cient for a cor­rect deci­sion.

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