Perfusion fluids Cost and Economics Dr.R.V.Raghavendra Rao M.S,M.Ch(SGPGI),FHPB,FLT(SNUH) Consultant Surgical Gastroenterologist and Liver Transplantation.

Perfusion fluids Cost and Economics

Dr.R.V.Raghavendra Rao M.S,M.Ch(SGPGI),FHPB,FLT(SNUH)

Consultant Surgical Gastroenterologist and Liver Transplantation SurgeonHyderabadMob:9866458511Email: [email protected]

Perfusion fluids Cost and Economics

The issue which has swept down the centuries and which will have to be fought sooner or later is the people versus the banks -Lord Acton

Perfusion fluids Cost and Economics

perfusion /per·fu·sion/ (-zhun)

The act of pouring over or through, especially the passage of a fluid through the vessels of a specific organ.

Dorland's Medical Dictionary for Health Consumers

per·fu·sion (p r-fy zh n)

The injection of fluid into a blood vessel in order to reach an organ or tissues, usually to supply nutrients and oxygen The American Heritage® Medical Dictionary

Perfusion fluids Cost and Economics

Perfusion fluids Cost and Economics

Commonly used fluids

University of Wisconsin (UW) solution

HTK Solution

Renograph / Marshal

Celsior - mainly cardiac

Perfadex – mainly pulmonary

Perfusion fluids Cost and Economics

Cost factors

Varies from INR 3500 to 26000/- per litre

Depends on

-Type of Fluid

-Import regulations

-Quantity (1lit vs 5 lit bags)

-Availability

Perfusion fluids Cost and Economics

Factors to be considered in cost analysis

Logical efficiency

Immediate graft function

Delayed Graft function

Spectrum of usage

Perfusion fluids Cost and Economics

Cost comparision between two commonly used solutions (UW vs HTK)

University of Pittsburg research report 2003

Alonso D, etal. Am J Transplant. 2008;8:1942-1945

StewartZA, et al. Am J Transplant. 2009;9:217-221

Robert J Stratta 2009

-UW 0n average USD 137.6 costlier than HTK/ Pt

Perfusion fluids Cost and Economics

A typical case (Involving Kidney and Liver)

Aorta perfusion - Marshal - 10000/-

(3lit) Portal perfusion - UW solution - 52000/- HTK - 48000/-

(1lit+1lit) (6lit)

Cold preservation-UW solution - 26000/- -8000/- (1lit)

Perfusion fluids Cost and Economics

Considerations for selection of perfusant to reduce costsSingle organ or multiorgan harvesting

DDLT vs LDLT

Brain Dead Vs NHBD

Standard or Extended criteria donors

Expected cold ishaemia time

Availability of solution

Perfusion fluids Cost and Economics

Factors which increase the cost of a preservative solution

Maintance of cold chain

Need for additional products before usage

Wastage during solution packaging

Perfusion fluids Cost and Economics

Recent DevelopmentsMachine perfusionCosts on average USD 3000 more

Moers, c. et al N. Engl. J. Med. 360, 7-29 (2009)

Buchanan, P. M. et al. Am. J. Transplant. 8, 2391-2401 (2008).

Gerrfield ss, et al. Tranplant proc.2009

Nov;41(9) : 3531-6

Perfusion fluids Cost and Economics

Reducing the costs

S selection of Donor

E

L Low volume flush (?)

E Efficiency

C Coordination between teams

T Transportation

You don't make the poor richer by making the rich poorer

- Sir Winston Churchill