Fibrinogen concentrate cost-effective than cryoprecipitate for managing bleeding in cardiac surgery patients: JAMA

The study points are:

• The participants were 495 adults from the FIBERS trial. These underwent cardiac surgery and acquired hypofibrinogenemia due to active bleeding requiring fibrinogen replacement.
• The primary outcomes were the number of Allogeneic Blood Products (ABPs) administered within 24 h and seven days of cardiopulmonary bypass.
• The mean age of participants was 59.2 years and was 69.3 % male.
• There were similarities in ABP transfusions and adverse events in both treatment groups.
• The median total 7-day allogenic blood product (ABP) transfusion cost was CAD $2280 in the fibrinogen concentrate group and CAD $2770 in the cryoprecipitate group.

• The median total 28-day cost was CAD $38 180 in the fibrinogen concentrate group and CAD $38 790 in the cryoprecipitate group.
• Fibrinogen concentrate vs cryoprecipitate incremental net benefit was positive after excluding critically ill patients before surgery, constituting 11 %
• Net benefit was highly uncertain for nonelective and patients with a critical illness.

To conclude, Fibrinogen concentrate is more cost-effective than cryoprecipitate. The researchers said that The incremental net benefit of fibrinogen concentrate vs cryoprecipitate was positive, with an 86% and 97% probability of being cost-effective at $0 and CAD $2000, respectively.

They mentioned that the generalizability of these findings outside the Canadian health system needs to be verified.

Further reading:

Abrahamyan L, Tomlinson G, Callum J, et al. Cost-effectiveness of Fibrinogen Concentrate vs Cryoprecipitate for Treating Acquired Hypofibrinogenemia in Bleeding Adult Cardiac Surgical Patients. JAMA Surg. Published online January 04, 2023. doi:10.1001/jamasurg.2022.6818