Transfusion-attributable acute respiratory distress syndrome, hospital utilization and costs in the USA: a model simulation

SUMMARY There are nearly 150,000 acute respiratory distress syndrome (ARDS) admissions in the USA, annually incurring 2.7 million hospital days. Although packed red blood cell (pRBC) transfusions increase the risk of developing ARDS, nearly one-half of intensive care unit (ICU) patients receive pRBCs. The rate of transfusion-attributable ARDS remains unknown. I estimated this annual rate, and the hospital utilization and costs in the USA. A model utilizing inputs from publicly available sources was constructed. Step 1 calculated the at-risk population. In step 2, the proportion of ARDS cases attributable to pRBC transfusion was estimated. Step 3 computed excess annual ARDS cases related to transfusion. Step 4 quantified hospital utilization and costs. Of 141,500 annual ARDS cases, 86,315 (61%) comprised at-risk population. Of those, 20% (n = 16,980) were estimated to be attributable to pRBCs, or 12% of all ARDS. In base-case analysis, using median hospital length of stay of 14 days and mean cost of $31,846 per case, aggregate annualized hospital days and costs were 237,720 and $599,241,180, respectively. This model demonstrates that pRBC transfusions may be responsible for a substantial number of ARDS cases. These cases may incur hospital costs of nearly $600 million. A restrictive transfusion strategy in appropriate at-risk ICU patients may be effective in mitigating the magnitude of this clinical and economic burden.