Table 2.
Direct hospital costs of a five-treatment inpatient course of therapeutic plasma exchange (TPE)
| Resource | Cost * |
|---|---|
| Tubing set and all other supplies ($210.08)a × 5 procedures | $1,050.40 |
| Direct RN labor cost (120 min × $0.79/min)b cost × 5 procedures | $474.00 |
| Insert central venous catheter (incl. catheter kit, supplies, x-rays); hospital costsc | $750.81 |
| 5% albumin × 5 proceduresd | $1,990.00 |
| TPE equipment amortizatione × 5 procedures ($52.59/procedure) | $262.95 |
| Service contract amortizationf × 5 procedures | $110 |
| TOTAL COST | $4,638.16 |
a CMS. CY 2010 Supplies file. PEAC (Practice Expense Advisory Committee) source for CPT 36514. March 2004 update.
b CMS. CY 2010 Labor file. PEAC source for CPT 36514. March 2004 update. For PE (CPT 36514), the CMS Labor file cites a labor cost of $0.42/minute, based on an RN/LVN operator. This value understates typical labor costs for a PE nurse operator, which is better approximated by the RUC value of $0.79/minute applied for therapeutic intravenous infusions; we used that higher labor rate in our cost model.
c CMS. CY 2010 payment amount for APC 0621. (Medicare-reported true median hospital cost for insertion of non-tunneled central venous catheter or PICC line; paid under APC 0621; surgeon's fee is separately paid.)
d 40 ml/kg 5% albumin (50 ml/kg total fluid volume replacement with 80% albumin:20% saline) × 70 kg patient × 5 procedures = 14,000 ml = 56 vials of 250 ml 5% albumin × $35.53/vial = $1,990 Albumin cost of $35.53 per vial represents the January 2011 provider contracted acquisition cost. Medicare payment rate is set at 95% of AWP for albumin, which serves as a proxy for hospital acquisition cost, distributor mark-up and direct overhead including storage, preparation and disposal costs.
e CMS. CPEP equipment file, March 2004 update (most recent data). Includes cell separator system, blood warmer and medical recliner chair, with useful lives of 6, 7 and 10 years (200 procedures per year) and costs of $59,320, $3,840 and $829, respectively.
f $4,450 annually per cell separator system (CaridianBCT device); assumes 200 procedures per year per device.