HTA 11

The clinical and cost effectiveness of thromboelastography/thromboelastometry

About the assessment

This Health Technology Assessment (HTA) reports on the clinical and cost effectiveness of using thromboelastography and thromboelastometry analysers compared with standard laboratory tests/assays and clinical discretion alone, to improve the diagnosis and subsequent management of patients experiencing unexplained blood loss during or after surgery.

Background

Thromboelastography and thromboelastometry are diagnostic point of care tests that measure multiple risk factors for coagulation, including initial clotting, platelet interaction and fibrinolysis in a sample of whole blood. They are used to assist with the diagnosis and management of haemostasis disorders, primarily during and after surgery that is associated with high blood loss. The complete results take up to 20 minutes to produce and inform on the presence and type of coagulation disorders. Treatment for such disorders may involve the transfusion of red blood cells and blood products. Timely and accurate diagnostic information should allow clinicians to take effective steps to manage the blood loss.

Results and conclusions

Thromboelastography/thromboelastometry, currently used in five Scottish hospitals, appears to be a cost-effective intervention. It has the potential to reduce the need for inappropriate transfusions and can decrease blood product requirements; this is likely to be welcomed by patients. Overall, thromboelastography/thromboelastometry appears to have a positive impact on patients¿ health by reducing the number of deaths, complications and infections, and increasing the number of life years and QALYs.

A further consequence observed was the reduction in the associated costs, related to the decrease in the number of transfusions, in the average usage of blood products and in the healthcare resources needed to deal with complications and infections. The results of the budget impact analysis showed that both for patients undergoing cardiac surgery and liver transplantation, savings are expected if thromboelastography/ thromboelastometry, instead of standard laboratory tests, is used for their management.

A summary of the recommendations contained within the HTA report is available here -

Understanding our Advice

This booklet has been produced to explain our advice on the use of thromboelastography/thromboelastometry to people who do not have specialist knowledge in this area. It explains what thromboelastography/thromboelastometry is, how we formed our advice and the evidence we considered.

This link opens in new browser window; you are now leaving the NHS QIS website.Understanding our Advice (PDF, 149K, 20secs)

Further information

For further information, or to receive a copy of the published report, please contact Doreen Pedlar at Doreen.Pedlar@nhs.net.

Published Date: 20 June 2007

Evidence

Healthcare Improvement Scotland took over the responsibilities of NHS Quality Improvement Scotland on 1st April 2011.