[e-drug] Rational and economic use of Plasma Expanders?

e-drug
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E-DRUG: Rational and economic use of Plasma Expanders?
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Dear E-Druggers,

In a country with an Essential Drugs Programme, some guidance in the rational use of a cost effective colloid for hypovolaemia, in a district hospital facility will be helpful.

The district hospital facility does minor surgery, emergency caesarean sections and circumcisions. All other surgery is referred to a higher level of care. The district facility has opted not to use the regular plasma expander, Plasmalyte B (1000 mL) costing R21.43.

The Provincial Pharmacy and Therapeutics Committee in an extended formulary coded Voluven i.e. poly (O-2-hydroxyethyl) starch 60G, NaCl 0.9 G/ 500ml for hypovolaemia and prophylaxis in prolonged surgery. The cost of the item is R54.72 for 500ml equating to R109.44 for 1000 mL.

In view of needs to spread the budget for the country's priority needs and cost difference of R88.01 per equal volume, is there a greater benefit in using Voluven over other blood volume expanders?

Your expertise and comments will be appreciated.

Sincerely,

Mariam Cassimjee.
B Pharm. M Pharm (UKZN).
Private Pharmacy Practice Consultant
South Africa
mims@telkomsa.net

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E-DRUG: Rational and economic use of Plasma Expanders? (2)
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Dear E-druggers

Mariam has raised an issue that has defeated many selection processes -
there seems to be no end to the crystalloid vs. colloid debate. There as
many adherents to one side as to the other, and equal numbers of critics
of each option. There are perhaps as many final answers as there are
"types" of clinical cases - be those elective surgery (and types of
surgery), trauma, adult, paediatric, renally-compromised or otherwise
altered function .... the list is endless.

As a result, systematic reviews have been of limited use. Below are the
abstracts and plain language summaries for a selection of Cochrane
Reviews to address the comparison or one or other of the options,
followed by an accessible summary of the issue from Intensive Care Unit:
Emergency Diagnosis and Treatment. Not that colloids also differ
markedly from one another, giving rise to yet another set of debates.

There are some head-to-head comparisons under way (e.g.
ClinicalTrials.gov Identifier: NCT00517127), but even these may not
resolve the entire question.

regards

Andy