Home > Journals > Minerva Anestesiologica > Past Issues > Minerva Anestesiologica 2001 June;67(6) > Minerva Anestesiologica 2001 June;67(6):457-65

CURRENT ISSUE
 

JOURNAL TOOLS

Publishing options
eTOC
To subscribe PROMO
Submit an article
Recommend to your librarian
 

ARTICLE TOOLS

Reprints
Permissions
Share

 

ORIGINAL ARTICLES  CRITICAL AND INTENSIVE THERAPY Free accessfree

Minerva Anestesiologica 2001 June;67(6):457-65

Copyright © 2009 EDIZIONI MINERVA MEDICA

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


PDF


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.

top of page