Cost-revenue analysis of using a haemoadsorbent membrane in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass and ticagrelor.

Background: Patients with acute coronary syndrome requiring coronary artery bypass graft surgery while on ticagrelor face a high risk of perioperative bleeding because of its strong antiplatelet effect. The Cytosorb® haemoadsorbent membrane (CytoSorbents Corporation, Princeton, NJ, USA), which is CE marked for ticagrelor removal, may help to mitigate this risk.

Aim: To evaluate the cost-revenue impact of the use of Cytosorb® membrane over two different time periods in a high-volume French hospital.

Methods: A retrospective cohort of patients who underwent coronary artery bypass grafting with ticagrelor without the use of Cytosorb® and a prospective cohort of patients of the same type undergoing coronary artery bypass grafting with the use of Cytosorb® were compared. The primary outcome was the budget impact of using Cytosorb® in patients undergoing coronary artery bypass grafting with ticagrelor. Secondary outcomes included morbidity criteria and the length of stay in different hospital departments.

Results: Among 40 patients, the cost difference favoured the cohort without Cytosorb® by €2670. However, the Cytosorb® group generated €635 more revenue per patient. Operative variables (duration, cardiopulmonary bypass time, transfusions) were similar, but the Cytosorb® group had a shorter stay in the intensive care unit. Sensitivity analysis highlighted membrane cost as the most influential factor in the overall cost difference.

Conclusion: In the French financial context, the use of the Cytosorb® in coronary artery bypass graft surgery with ticagrelor leads to additional costs, despite a slight revenue increase and the potential benefit of a shorter stay in the intensive care unit.