{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:05:35Z","timestamp":1790784335651,"version":"4.1.0"},"reference-count":24,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2023,3,1]]},"abstract":"<jats:sec id=\"ab-soi220100-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Excessive bleeding requiring fibrinogen replacement is a serious complication of cardiac surgery. However, the relative cost-effectiveness of the 2 available therapies\u2014fibrinogen concentrate and cryoprecipitate\u2014is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi220100-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine cost-effectiveness of fibrinogen concentrate vs cryoprecipitate for managing active bleeding in adult patients who underwent cardiac surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi220100-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>A within-trial economic evaluation of the Fibrinogen Replenishment in Surgery (FIBRES) randomized clinical trial (February 2017 to November 2018) that took place at 4 hospitals based in Ontario, Canada, hospitals examined all in-hospital resource utilization costs and allogeneic blood product (ABP) transfusion costs incurred within 28 days of surgery. Participants included a subset of 495 adult patients from the FIBRES trial who underwent cardiac surgery and developed active bleeding and acquired hypofibrinogenemia requiring fibrinogen replacement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi220100-7\">\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Fibrinogen concentrate (4 g per dose) or cryoprecipitate (10 units per dose) randomized (1:1) up to 24 hours postcardiopulmonary bypass.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi220100-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Effectiveness outcomes included number of ABPs administered within 24 hours and 7 days of cardiopulmonary bypass. ABP transfusion (7-day) and in-hospital resource utilization (28-day) costs were evaluated and a multivariable net benefit regression model built for the full sample and predefined subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi220100-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patient level costs for 495 patients were evaluated (mean [SD] age 59.2 [15.4] years and 69.3% male.) Consistent with FIBRES, ABP transfusions and adverse events were similar in both treatment groups. Median (IQR) total 7-day ABP cost was CAD $2280 (US dollars [USD] $1697) (CAD $930 [USD $692]-CAD $4970 [USD $3701]) in the fibrinogen concentrate group and CAD $2770 (USD $1690) (IQR, CAD $1140 [USD $849]-CAD $5000 [USD $3723]) in the cryoprecipitate group. Median (interquartile range) total 28-day cost was CAD $38\u202f180 (USD $28\u202f431) $(IQR, CAD $26\u202f350 [USD $19\u202f622]-CAD $65\u202f080 [USD $48\u202f463]) in the fibrinogen concentrate group and CAD $38\u202f790 (USD $28\u202f886) (IQR, CAD $26\u202f180 [USD $19\u202f495]-CAD $70\u202f380 [USD $52\u202f409]) in the cryoprecipitate group. After exclusion of patients who were critically ill before surgery (11%) due to substantial variability in costs, the incremental net benefit of fibrinogen concentrate vs cryoprecipitate was positive (probability of being cost-effective 86% and 97% at $0 and CAD $2000 (USD $1489) willingness-to-pay, respectively). Net benefit was highly uncertain for nonelective and patients with critical illness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi220100-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>Fibrinogen concentrate is cost-effective when compared with cryoprecipitate in most bleeding adult patients who underwent cardiac surgery with acquired hypofibrinogenemia requiring fibrinogen replacement. The generalizability of these findings outside the Canadian health system needs to be verified.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamasurg.2022.6818","type":"journal-article","created":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T11:01:49Z","timestamp":1672830109000},"page":"245","source":"Crossref","is-referenced-by-count":28,"title":["Cost-effectiveness of Fibrinogen Concentrate vs Cryoprecipitate for Treating Acquired Hypofibrinogenemia in Bleeding Adult Cardiac Surgical Patients"],"prefix":"10.1001","volume":"158","author":[{"given":"Lusine","family":"Abrahamyan","sequence":"first","affiliation":[{"name":"Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada"},{"name":"Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada"},{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, 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Canada"},{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"2","key":"soi220100r1","doi-asserted-by":"publisher","first-page":"R76","DOI":"10.1186\/cc12685","article-title":"Management of bleeding and coagulopathy following major trauma: an updated European guideline.","volume":"17","author":"Spahn","year":"2013","journal-title":"Crit Care"},{"issue":"2","key":"soi220100r2","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1051\/ject\/202153097","article-title":"STS\/SCA\/AmSECT\/SABM Update to the clinical practice guidelines on patient blood management.","volume":"53","author":"Tibi","year":"2021","journal-title":"J Extra Corpor 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