Sigmund H, Danneskjold-Samsoe B; International Society of Technology Assessment in Health Care. Meeting.

Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1998; 14: 59.

Danish Institute for Health Services Research and Development (DSI), Copenhagen, Denmark.

OBJECTIVE: In an International Study of Peri-Operative Transfusion (ISPOT) we have assessed 4 drugs (aprotinin, desmopressin, tranexamic acid, erythropoietin) and 3 techniques (acute normovolemic hemodilution, autotransfusion, autologous pre-donation) to reduce allogeneic blood transfusion. The study, which was carried out in 10 countries, reveals use of the technologies, and attitudes to risks, benefits, cost-effectiveness, and comprises a practice variation study conducted as national projects. The results of the Danish part of the study are influenced by: the size of Denmark, a publically financed health care system, fairly autonomously operating hospital blood banks and voluntary donors organised in local donor corps. There is a considerable value attached to giving blood within the Danish society. The aim of the Danish project was to describe current use of the 7 technologies, to uncover and explain variation in practice, and to identify barriers to diffusion. METHOD: To assess patterns of use of the technologies, an initial mailed survey was carried out comprising all the surgical units in all Danish hospitals - 228 departments covering 10 specialties in 61 hospitals. Response rate: 95%. After having identified users and non-users, an extensive mailed follow-up survey was conducted in order to elaborate on the information obtained, and to determine factors affecting the diffusion of the technologies. Response rate: 85%. RESULTS: In Denmark, more than 50% of the surgical units (more than 80% of the hospitals) use one or more of the technologies. Transexamic acid is commonly used, while erythropoietin, aprotinin, and especially desmopressin are rarely used. Preoperative autologous donation is not used (in part due to costs), acute normovolemic hemodilution is rarely used and very little known, while autotransfusion/call salvage is used in 20 hospitals, and it attracts increasing attention. The clinicians find the level of use appropriate, some find it too low. Non-use of a technology is explained by a lack of familiarity with the technology or lack of experience, while concerns about effectiveness and costs are secondary explanations. CONCLUSIONS: The technologies are not widely diffused in Denmark, mostly due to lack of knowledge and experience. This emphasizes a need for more information on effectiveness, and a public debate of these techniques to reduce allogeneic blood transfusion.

Publication Types:

• Meeting Abstracts

Keywords:

• Aprotinin
• Blood Transfusion
• Blood Transfusion, Autologous
• Data Collection
• Denmark
• Erythropoietin
• Erythropoietin, Recombinant
• Hemodilution
• Hospitals
• Tranexamic Acid
• hsrmtgs

Other ID:

• HTX/98620141

UI: 102234705

From Meeting Abstracts