Budget Impact Analysis of Sorbent Hemadsorption during Emergency Cardiac Surgery in Ticagrelor-Loaded Patients

Objectives: CytoSorb is a sorbent that can reduce Ticagrelor levels in the human blood (CytoSorbents Inc., USA). The method was found to be effective to prevent from major bleeding complications during emergency cardiac operations. This analysis was done to investigate the budget impact of CytoSorb adsorption in emergency cardiac surgery in patients loaded with Ticagrelor.

Methods: A Bootstrap analysis with 1,000 samples with 100 observations each (50:50) was performed based on data from a retrospective single-center case series, which comprises 32 patients with CytoSorb therapy and 11 without (all had undergone emergency open-heart surgery at our institution). Probabilistic multivariable analysis was performed by Monte Carlo simulations and one-way sensitivity analysis was done to test for several cost driving variables.

Results: Compared to the control group, CytoSorb patients had 72% less transfusions of red blood cells and/or platelets, 33% less days on the intensive care unit (ICU), and 18% shorter operation time. A significantly higher rethoracotomy rate in the control group was also associated with prolonged ICU stay and the use of more blood products. Cost of ICU stay had the highest impact on the level of cost savings. Sorbent hemadsorption remained cost saving irrespective of variations in cost driving variables. The economic benefit was calculated as 3.656¢ per patient without reimbursement.

Conclusion: When used intraoperatively during emergency cardiac surgery of Ticagrelor-loaded patients, CytoSorb leads to cost savings due to a reduction in ICU length of stay, reduction of blood products used, and shorter operation time.