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    Cost-Effectiveness and Clinical Outcome of Transcatheter Versus Sutureless Aortic Valve Replacement
    (Forum Multimedia Publishing, Llc, 2023) Indelen, Cenk; Bas, Tolga; Kar, Ahmet; Ergenc, Ebsar; Karademir, Burcin Cayhan; Sismanoglu, Mesut; Kirali, Kaan
    Background: Sutureless aortic valve replacement (SU-AVR) and transcatheter aortic valve implantation (TAVI) are becoming increasingly common. The aim of this study is to compare the clinical outcome and cost-effectiveness of the two methods. Methods: In this study, cross-sectional retrospective data were collected on 327 patients who un-derwent SU-AVR (n = 168) and TAVI (n = 159). Homo-geneous groups were provided by the propensity score matching method, and 61 patients from the SU-AVR group and 53 patients from the TAVI group were included in the study sample. Results: The two groups did not have sta-tistically different death rates, complications after surgery, lengths of hospital stays, or visits to the intensive care unit. It is stated that the SU-AVR method provides an additional 1.14 Quality-Adjusted Life Year (QALY) compared to the TAVI method. The TAVI was more expensive than the SU-AVR in our study, but the difference was not statistically significant ($40,520.62 vs. $38,405.62, p > 0.05). For SU-AVR, the most expensive factor was the length of stay in the intensive care unit; for TAVI, it was arrhythmia, bleed-ing, and renal failure. Conclusions: These bioprostheses are safe and effective treatments for valve stenosis. Clini-cal outcomes were similar between the two groups. There-fore, clinicians may find it difficult to determine an effec-tive treatment strategy. According to the evaluation made in terms of cost-effectiveness, it was found that the SU-AVR method gave a higher QALY at a lower cost compared to the TAVI method. However, this result is not statistically significant.
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    The cost of one unit blood transfusion components and cost-effectiveness analysis results of transfusion improvement program
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2021) İndelen, Cenk; Kizmaz, Yecim Uygun; Kar, Ahmet; Shander, Aryeh; Kirali, Kaan
    Background: This study aims to analyze the cost of the entire transfusion process in Turkey including evaluation of the cost of transfusion from the perspective of hospital management and determination of savings achieved with the transfusion improvement program. Methods: Invoices, labor, material costs were calculated with micro-costing method, while general production expenses were calculated with gross costing method between January 2018 and December 2019. Unit costs for each blood product were calculated separately by collecting unit acquisition costs, material costs, labor costs, and general production expenses and, then, distributed into six different blood products as follows: erythrocyte suspension, fresh frozen plasma, pooled platelet, apheresis platelet, cryoprecipitate, fresh whole blood. The total costs for 2018 and 2019 were calculated and the savings achieved were estimated. The Turkish Lira was converted into the United States Dollar ($) currency using the purchasing power parity. Results: In 2018/2019, the blood component transfusion cost was $240.90/251.18 for erythrocyte suspension, $120.00/128.67 for fresh frozen plasma, $313.50/322.19 for pooled platelet, $314.24/325.73 for apheresis platelet, $104.95/113.99 for cryoprecipitate, and $189.91/209.09 for fresh whole blood. The total transfusion cost was $6,224,208.33 in 2108 and $5,308,148.43 in 2019. As a result of the transfusion improvement program launched in 2019, the amount of blood components decreased by 23.24%, compared to the previous year, and a saving of $916,059.9 was achieved. Conclusion: The transfusion is a burden for both the hospital management systems and the country's economy. To accurately calculate and manage this economic burden is important for sustainable healthcare services.