Background For patients hospitalised in our intensive care unit (ICU), continuous venovenous haemofiltration (CVVH) with citrate has been implemented since 2013. This study was conducted to assess the change in practices and restitution fluids (RF), analysing the impact on consumption and costs. Reflection on this was conducted between physicians, nurses and pharmacists.
Purpose The aim of the study was to assess the cost implications of citrate anticoagulation.
Material and methods We performed a retrospective study in the ICU in patients requiring CVVH in 2014. Data collected were: patient characteristics (age, sex ratio, BMI, IGS2) and CVVH data (indications, effective duration, filters, RF, calcium and phosphorus consumption). Prescription data allowed estimation of the total cost with RF, filters and ion consumption. Costs of other RF with integrated ions were used to simulate the cost impact. Results were expressed for 24 h of effective CVVH. The citrate and non-citrate groups were compared with the Student’s test (significant if p < 0.05).
Results We included 64 patients. They had a mean age of 68.1 ± 16.6 years, a mean SAPS II of 58.2 ± 20.5, a mean stay in the ICU of 9.0 ± 9.6 days and a mortality rate of 28.1%. Volume overload was an indication for CVVH in 46.8% of patients, hyperkaliaema in 31.2% and acidosis in 14.2%. Duration was <24 h for 39.2% (n = 29) of CVVH, 65.6% of them because of recovery to normal conditions. Citrate anticoagulation was used in 40.0%. Regarding CVVH (n = 74), mean effective duration was 52.1 ± 60.7 h. Effective duration was <24 h for 39.2% (n = 29) of CVVH, 65.6% stopped because of recovery to normal conditions. Total cost represented 70 385€. There was no statistically significant difference between mean cost/24 h in the citrate and no citrate groups (p = 0.33). Cost simulations with RF with integrated ions were significantly less expensive with a mean economy of 48.3€/24 h (p < 0,001), a total economy of 5726.3€/year.
Conclusion This study highlighted an interesting assessment of CVVH practices. Simulations showed that 5726.3€ could be saved with integrated ion RF, especially as it did not take into account human costs. Most CVVH were shorter than 24 h and reflection about intermittent haemofiltration is needed. Evaluation of the cost impact of fluid and material consumption in the ICU could help physicians and pharmacists to identify where some interesting savings could be made.
No conflict of interest.
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