Background: Current cesarean delivery (CD) rates in many industrialized countries are well above the recommended rates. Objective: The overall goal of this thesis was to identify sources for unnecessary CD. Specific objectives were to: 1) analyze the leading indications for CD and their associations with neonatal outcomes; 2) compare adverse birth outcomes between elective primary cesarean delivery (EPCD) and trial of labor after vaginal birth (TOLAV), and between elective repeat cesarean delivery (ERCD) and trial of labor after cesarean birth (TOLAC); and 3) assess the cost-effectiveness of ERCD and TOLAC. Methods: A retrospective cohort study was conducted. Leading indications for CD were analyzed and risks of neonatal outcomes between “soft” indications and “hard” indications were compared first, using 2006 to 2013 Better Outcomes and Registry Network Ontario data. A pair of analyses: comparing risks of adverse birth outcomes between EPCD and TOLAV and between ERCD and TOLAC, were then conducted using United States 2005 to 2010 birth registration data. Analysis were performed using logistic regression and propensity score matching models. Finally, a cost-effectiveness analysis between ERCD and TOLAC was performed. Results: The single largest contributor for overall CD was ERCD (34.3%) and for primary CD was dystocia (31.9%) in Ontario. Compared with infants of mothers with CD for “hard” indications, the risks of Apgar score <7 at 5 minutes for infants of mothers with CD for non-reassuring-fetal-status was increased, while the risks of Apgar score <7 at 5 minutes and neonatal death for infants of mothers with ERCD and dystocia were decreased. Compared with infants of mothers who underwent TOLAV, infants of mothers who underwent EPCD were more likely to require antibiotics and ventilation support, but less likely to have birth injury. On the other hand, compared with infants of mothers who underwent TOLAC, infants of mothers who underwent ERCD were less likely to require antibiotics and ventilation support. ERCD was similar to the TOLAC birth option in terms of cost effectiveness. Conclusions: Tight up criteria for “soft” indications such as labor dystocia could result in substantial reduction in CD without harming the infants.

The thesis is concentrated on the analysis of the decision - making process. Concretely in the case of building-up of R35 highway. The analysis describes landscape planing process, strategic environmental assessment process, environmental impact assessment process, planing inquiry and buliding control. I'm trying to find optimum alternate of building-up of the highway as a combination of economic,environmental,technological and social point of view.

Le Staphylocoque aureus (S. aureus) est une bactérie pouvant causer des infections d’origine communautaire ou hospitalière. En plus des personnes pouvant être infectées par S. aureus, de nombreux individus environ 20-25% parmi les adultes en bonne santé, portent ce pathogène sur leurs corps (ils sont dits "colonisés"). Bien qu’asymptomatique et souvent bénigne, la colonisation à S. aureus peut rarement impliquer un risque d’infection secondaire grave mais représente un risque d’être transmise à une tierce personne. A l’hôpital, le risque d’infection et de transmission apparaît comme étant particulièrement haut pour la souche de S. aureus résistante à la méticilline (SARM). La prévention et la lutte contre le SARM est un problème de santé publique important. Les Nation Unis se sont récemment engagés dans cette lutte en créant le"Global Action Plan on Antimicrobial Resistance". Ce travail de thèse traite de trois différentes études dans la cadre de la prévention et du contrôle de ce pathogène. / Staphylococcus aureus is a bacterium that can cause blood infections that can have a community or hospital origin. Among people infected with S.aureus, about 20-25% is healthy adults that carry the pathogen on their bodies, without suffering any symptom (they are said "colonized"). Although asymptomatic and often benign, colonization with S. aureus involves a risk of secondary infection and represents a serious risk of transmission to a third party. In hospitals, the risk of infection and transmission appears to be unusually high for methicillinresistant S. aureus (MRSA) and complications can be very severe. Prevention and the fight against MRSA is a major public health concern. The United Nations recently engaged in this struggle by creating the "Global Action Plan on Antimicrobial Resistance". This work is about three different studies in the prevention and control of this pathogen.

Les nouvelles technologies de l'information et de la communication constituent des outils utiles pour améliorer le système de santé. Les décisions relatives à leur mise en œuvre ainsi qu'à leur utilisation doivent être basées sur des observations solides pour évaluer les impacts sur les soins et la santé. L'utilisation difficile des méthodes d'évaluation économique est due à la multidimensionnalité de l'évaluation des implémentations de télémédecine. En effet, pour évaluer l'impact de l'introduction de la télémédecine, il est nécessaire de prendre en compte les indicateurs divers identifiées dans la littérature. En outre, ils doivent être considérés par rapport à tous les acteurs impliqués dans le processus de décision. Dans ce contexte, l'aide multicritère à la décision peut fournir des informations supplémentaires sur l'évaluation de la télémédecine. L'objectif de cette thèse est de présenter une méthodologie d'évaluation multicritère impliquant de multiples décideurs pour la mise en place d'unité de dialyse médicalisée avec télémédecine (UDMT). Pour prendre une décision, le directeur de l'hôpital souhaite prendre en compte, à côté des indicateurs mentionnés ci-dessus, les préférences des médecins et des patients. Pour expliciter ces préférences, nous suggérons de considérer que les patients et les médecins sont des décideurs qui exprime un classement des différentes modalités de soins qui sont évaluées sur plusieurs critères. Nous sommes face à une situation impliquant plusieurs juges qui recouvrent une multiplicité de points de vue. Pour résoudre ce problème, nous utilisons des techniques à la fois de la théorie du choix social et de l'aide multicritère à la décision. D'abord, nous proposons d'agréger les classements individuels des patients sur les différentes modalités de soins, ce classement est ensuite utilisé dans la phase d'élicitation des préférences des médecins. Les classements individuels de ces derniers sont ensuite agrégées dans un classement des médecins qui est ensuite combiné avec celui de patients et d'autres critères économiques pour déterminer les préférences du directeur d'hôpital sur les modalités de soins. Cette méthodologie est appliquée à la mise en œuvre d'unités de dialyse médicalisées en Bretagne, sur la base des préférences de patients, médecins et directeur de l'hôpital. Les préférences de tous les acteurs de ce processus de décision sont représentables par des modèles d'utilité additives. L'alternative préférée parmi les patients et les médecins est l'UDMT. Le critère qui a le plus d'impact sur la décision des patients (resp. Les médecins) est la distance de l'unité de dialyse (resp. La satisfaction des patients). Enfin, l'analyse montre que les critères les plus importants pour le directeur de l'hôpital sont la satisfaction des médecins et des patients. Ce travail montre qu'il est important de tenir compte de l'hétérogénéité et de la multiplicité des points de vue et des acteurs dans l'évaluation. / The new information and communication technologies represent useful tools for improving the health system. Decisions on their implementation and use must be based on solid observations to assess their impacts on care and health. The difficult use of classical economic evaluation methods is due to the multidimensionality of the assessment of telemedicine implementations. Indeed, to evaluate the impact of the introduction of telemedicine, it is necessary to take into account various indicators identified in the literature, as cost, accessibility, acceptability and quality. Furthermore, they need to be considered with respect to all the stakeholders involved in the decision process. In this context, decision support theories provide additional insight into the evaluation of telemedicine. The objective of this thesis is to present a multicriteria evaluation methodology involving multiple decision makers for the establishment of remotely monitored medical dialysis (RMMD) solutions. To reach a decision, the hospital director wishes to take into account, next to the above mentionned indicators, the preferences of the physicians and the dialysis patients. In order to explicit these preferences, we suggest to consider that the patients and the physicians are decision makers which have to express a ranking of care modalities evaluated on multiple criteria. We thus face a situation involving multiple judges which overlay a multiplicity of viewpoints. To solve this problem, we use techniques both from social choice theory and multicriteria decision analysis. First we propose to agregate the individual rankings of the patients on the potential multicriteria care modalities into a patient-wide order, which is then used in the multicriteria preference elicitation phasis of the physicians. The individual rankings of the latter ones is then aggregated into a physician-wide ranking which is then combined with the patients' one and further economical criteria to elicit the hospital director's preferences on the care modalities. This methodology is applied to the implementation of medical dialysis units in Brittany (France), on basis of the preferences of 16 patients, 8 physicians and 1 hospital director. The preferences of all the stakeholders of this decision process are representable by additive value models. The preferred alternative among the patients and the physicians is the medical dialysis unit with remote monitoring. The criterion which has the highest impact on the patients' (resp. physicians') decision is the distance to the dialysis unit (resp. the patients' satisfaction). Finally, the analysis shows that the most important criteria for the hospital director are the physicians' and the patients' satisfaction. This work shows that it is important to consider the heterogeneity and the multiplicity of viewpoints and actors in the evaluation of the implementation of RMMD solutions via multicriteria decision support techniques.

Les thérapies ciblées ont permis d’augmenter la survie des patients souffrant de cancers et d’améliorer leur qualité de vie, avec un coût de traitement plus élevé que pour les chimiothérapies conventionnelles. L’Évaluation Médico-Économique (EME) repose le plus souvent sur des modèles mathématiques qui nécessitent l’utilisation de données cliniques, économiques et de qualité de vie. De manière générale, l’EME utilise des données collectées dans les essais cliniques, la littérature et à dires d’experts. Cependant, il est de plus en plus difficile de disposer d’un essai comparant le traitement A au traitement B (comparaison directe (CD)). De ce fait, les EME utilisent de plus en plus des données issues de comparaisons indirectes (CI). Par ailleurs, les différences entre la population des essais et celle traitée en vie réelle, peuvent rendre difficile l’extrapolation des résultats des essais à la population traitée en vie réelle. Les modèles médico-économiques sont sensibles aux paramètres utilisés ainsi qu’aux méthodes employées pour les estimer. Ainsi, l’efficience en vie réelle peut différer de l’efficience estimée à partir des données d’essais. De même, l’utilisation de données issues de CI vs celle issues de CD peut avoir un impact sur les résultats d’efficience. Cette thèse avait pour objectif d’évaluer l’impact des différentes sources de données (CD, CI et données collectées en vie réelle) sur les résultats d’efficience. Et ce, à travers une étude de cas qui est l’EME de pazopanib vs sunitinib dans le traitement de 1re ligne du Cancer du Rein Métastatique (CRM). Pour répondre aux objectifs de la thèse, nous avons utilisé un modèle partitionné de survie et avons analysé les résultats issus de trois scenarii différents, scénario : CD, CI, et vie réelle. Pour dériver les paramètres du modèle, nous avons réalisé trois analyses rétrospectives de bases de données. Pour les scenarii basés sur les données de CD et données de CI, les coûts étaient collectés à partir de sources de données multiples (PMSI, Oncology Analyzer et la litterature) et les données d’efficacité étaient collectées respectivement à partir d’un essai clinique et d’une CI comparant pazopanib à sunitinib. Pour le scénario vie réelle les coûts et les données de survie étaient collectées à partir du DCIR. Les données d’utilité utilisées étaient identiques pour les trois scenarii. Les résultats du scénario CD montrent que pazopanib est plus efficace et moins coûteux que sunitinib. En revanche, les résultats des scenarii CI et vie réelle montrent que pazopanib était plus efficace et plus coûteux que sunitinib. Bien que les résultats de ces deux derniers scenarii aboutissent à la même conclusion, il y a une grande variabilité sur le Ratio Différentiel Coût Résultat (RDCR) pouvant aboutir, selon la disposition à payer, à des décisions différentes. Les analyses de sensibilité montrent que les résultats étaient sensibles aux données d’utilité mais également aux données de coûts utilisées. La thèse met en évidence une grande disparité des résultats du fait des données disponibles pour mesurer l’efficience en vie réelle ou à partir des essais (CD, CI). Nous constatons qu’une faible variation de l’estimation des données de survie a un impact important sur les données d’efficience. Par ailleurs, afin de réduire l’incertitude autour des résultats d’efficience, des travaux préliminaires relatifs à l’harmonisation des méthodes pour estimer les données de coûts à partir du DCIR doivent être réalisés. Pour finir, quel que soit le scénario étudié, nous avons constaté une grande incertitude autour des paramètres utilisés et en conséquence autour des résultats d’efficience. Il serait donc important de modéliser la valeur de l’information afin de déterminer les études à mettre en place pour réduire l’incertitude autour des résultats d’efficience. / Targeted therapies have improved the survival of patients suffering from cancer. However, due to the introduction of new targeted therapies, treatment costs have rapidly increased. In this context, Economic Evaluation (EE) proposes a set of tools in healthcare decision making. EE is usually based on decision modeling that requires a set of clinical, economical and quality of life data. These data are often collected in randomized controlled clinical trials also called Direct Comparisons (DC), in the literature and on the basis of experts’ opinions. Yet, it is not always possible to conduct a clinical trial that directly compares treatment A to treatment B. Therefore, the use in EE of statistical techniques that uses results from separate clinical trials to compare the efficacy between treatment A and B is increasing. One of these techniques is called Indirect Comparisons (IC). Differences in patients’ characteristics between the population in the trial and the one treated in practice, makes it difficult to extrapolate the results of clinical trials to the population treated in real life. Moreover, analytic decision models are often sensitive to clinical, quality of life and costing parameters. Hence, real life cost-effectiveness may differ from the cost-effectiveness based on clinical trials data. In addition, the use of indirect comparisons in decision analytic modeling may yield different results from the use of data collected in head to head trials. The objective of this thesis was to evaluate the impact of using different data sources (DC, IC and real life data) on the results of a decision analytic model. To attain our objectives, the effectiveness of pazopanib versus sunitinib in first line treatment of patients with metastatic Renal Cell Carcinoma (mRCC) was used as a case study. To evaluate the impact of different data sources on the cost-effectiveness results, we used a partioned survival model and compared the results of three different scenarios: direct comparison, indirect comparison and real life. In order to derive the parameters used in the model, we conducted three retrospective database analyses. For DC and IC scenarios, cost data were collected using multiple data sources (PMSI, Oncology Analyzer and the literature) and clinical data were collected respectively in a clinical trial and from an indirect comparison comparing pazopanib to sunitinib. Costs and survival data used in the real life scenario were collected in the DCIR. Similar utility values were used for the three scenarios. In the DC scenario, pazopanib was found to be more effective and less costly than sunitinib. However, for both IC and real life scenarios, pazopanib was found to be more effective and costlier than sunitinib. Even though both scenarios found pazopanib more effective and costlier than sunitinib, there is an important variability on the Incremental Cost-Effectiveness Ratio (ICER) that may lead to different decisions according to the willingness to pay. Sensitivity analyses showed that the results were sensitive to utility and cost data. This thesis highlighted the disparity of the cost-effectiveness results based on clinical trial data (CD and IC) and those estimated using real life data. We observed that a small variation in survival data estimates has a significant impact on the cost-effectiveness results. In order to reduce uncertainty around real life cost-effectiveness, a preliminary work on harmonizing the methods used to estimate cost data from the DCIR must be performed. Furthermore, no matter the scenario studied, we observed a great uncertainty regarding the cost-effectiveness of pazopanib versus sunitinib in first line treatment of mRCC patients. Hence the importance of modeling the value of information to identify the studies that should be implemented in order to reduce the uncertainty around the cost-effectiveness results.

Background and Objectives: Economic evaluation and decision analysis provide a framework to evaluate incremental costs and effects associated with alternative health interventions. These methods can also be used as a tool to evaluate alternative clinical behaviours or practice patterns. The objective of this thesis was to investigate the impact of current Canadian practices in human epidermal growth factor receptor-2 (HER2) testing to target trastuzumab in early-stage breast cancer (BC). Methods: Project 1: A systematic review of previous trastuzumab and HER2 testing economic analyses was conducted to identify methodological gaps and key lessons. Project 2: A population-level, retrospective cohort was studied to determine HER2 testing and trastuzumab treatment patterns in Ontario early-stage BC patients. Project 3: A cost-utility analysis of alternative test-treat strategies was conducted using a Markov model of BC calibrated to the Canadian setting, and incorporating Project 2 findings. Results: Project 1: Previous economic evaluations demonstrated that HER2 test accuracy and sequencing were key considerations when modelling the cost-effectiveness of trastuzumab treatment. Consideration of local testing and treatment practices was lacking. Project 2: HER2 testing and treatment practice differed from guidelines, where documentation was available. Only 88% of equivocal results were confirmed, while 57% of HER2 positive patients received trastuzumab. Project 3: Calibration of the BC model minimised gaps between trial-based survival and expected Canadian survival patterns. Deviations from guidelines in practice suggest that primary testing with fluorescence in situ hybridization (FISH) would produce greater health gains at a reduced cost vs. primary immunohistochemistry with FISH confirmation. This finding was more apparent as the prevalence of HER2 positive disease increased. Introduction of newer in situ hybridisation tests may be cost-effective as well. Conclusions: Practice deviations from guidelines are an important consideration when modelling the cost-effectiveness of trastuzumab therapy. Underlying local disease progression and prevalence can also significantly impact outcomes. / Dissertation / Doctor of Philosophy (PhD)

This thesis explores the use of observational microdata in cost-effectiveness analysis. The application of econometric methods adjusting for selection bias is first reviewed and critically appraised in the economic evaluation literature using a structured template. Limitations of identified studies include lack of good quality evidence regarding the performance of different analytical approaches; inadequate assessment of the sensitivity of their results to violations of fundamental assumptions or variations to crucial estimator parameters; failure to combine the cost and effectiveness outcomes in a summary measure; and no consideration of stochastic uncertainty for the purpose of evaluating cost-effectiveness. Data from the Birthplace national cohort study are used in an attempt to address these limitations in the context of an empirical comparison of estimators relying on regression, matching, as well as the propensity score. It is argued that although these methods cannot address the potential impact of unobservable confounding, a novel approach to bias-corrected matching, combining entropy balancing with seemingly unrelated regression, still has the potential to offer important advantages in terms of analytical robustness. The net economic benefit is proposed as a straightforward way to exploit the strengths of rigorous econometric methodology in the development of reliable and informative cost-effectiveness analyses.

A centrifugação é o principal método utilizado para fracionar o Sangue Total (ST) nos componentes sanguíneos: Concentrados de Hemácias (CH), Concentrados Plaquetas (CP), Plasma e Crioprecipitado, (também chamados de Hemocomponentes). Com intuito de prevenir ou controlar hemorragias, os CP obtidos por centrifugação tornaram-se o padrão no atendimento inicial aos pacientes com baixas contagens de plaquetas. Porém, para obter uma unidade terapêutica (UT), no Hemocentro RP, é necessário agregar seis CP, formando o Pool de CPST (PCP), o que leva a exposição do receptor a vários doadores diferentes. O CP obtido por aférese (CPAF), advindo de equipamento que permite a seleção já na coleta, fornece a dose necessária em apenas uma doação. Baseado no levantamento de dados internos do Hemocentro de RP o presente estudo analisou, através da metodologia de Custeio Baseado em Atividade (ABC), os custos atribuídos às distintas metodologias para a produção dos CP, sabendo que no Hemocentro RP, os CP são dispensados como UT independente da forma de obtenção. Os resultados obtidos foram utilizados na Análise de Custo-Efetividade, evidenciando que a coleta por Centrifugação de ST com a produção de PCP foi mais custo efetiva em 2015 do que a coleta de aférese, porém, por uma diferença relativamente pequena, devido ao grande percentual de obtenção de dupla Unidade Terapêutica (CPAF2). / Centrifugation is the main method used for fractionating Total Blood (TB) to blood components: Red Cells Concentrate (CR), Platelet Concentrates (PC), Plasma and Cryoprecipitate (also called Hemocomponents). In order to prevent or control bleeding, CPs obtained by centrifugation became the standard treatment of patients with low platelet counts. However, to obtain a therapeutic unit (TU), at Hemocentro RP, it is necessary to get together six PCs, forming a Pool of TBPC (PCP), exposing the receptor to several different donors. PC obtained by apheresis (CPAF), which is provided by a equipment that allows selective collection, achieve the dose necessary for the selection in just one donation. Based on the collection of internal data from the Hemocentro RP, the present study analyzed, through the methodology of ActivityBased Costing (ABC), the costs attributed to the different methodologies for the production of PCs knowing that in the Hemocenter RP PCs are dispensed as TU independent of the way of obtaining. The results obtained were used in the CostEffectiveness Analysis, showing collecting by TB Centrifugation producing PC is more cost-effective, however CPAF was almost as effective as in 2015, a great achievement of Dual Therapeutic Unit in a single donation (CPAF2).

Critical Access Hospitals (CAHs) – the predominant type of hospital operating in rural areas – play an integral role in the US healthcare system, providing care for over 7 million rural residents each year who might otherwise have no local access to urgent care or inpatient services. This dissertation examines three aspects of care delivery in CAHs – effectiveness, cost/efficiency, and access – each of which has separate implications for policy and practice. The first study addresses effectiveness and evaluates the performance of CAHs on specific patient safety indicators compared to small Prospective Payment System (PPS) hospitals. A total of 35,674 discharges from 136 non-federal general hospitals with fewer than 50 beds were included in the analyses: 14,296 from 100 CAHs and 21,378 from 36 PPS hospitals. Outcome measures included six bivariate indicators of adverse events of surgical care that were developed from Agency for Healthcare Research and Quality Patient Safety Indicators. Multiple logistic regression models were developed to examine the relationship between hospital adverse events and CAH status. The results indicated that compared to PPS hospitals, CAHs are less likely to have any observed (unadjusted) adverse event on all six indicators, four of which are statistically significant. After adjusting for patient mix and hospital characteristics, CAHs perform better on three of the six indicators. Accounting for the number of discharges eliminated the differences between CAHs and PPS hospitals in the likelihood of adverse events across all indicators except one. Tele-emergency (tele-ED) services can address several challenges facing emergency departments (EDs) in rural areas. The second study investigates access and characterizes the impact of a rural-ED-based telemedicine program on discharge disposition in terms of patient transfer, local hospital admission, and routine discharge. This study tests the hypothesis that telemedicine enhances access by allowing patients to receive care in the local community, and does so by looking at the probability of transfer and local admissions before and after telemedicine was implemented in CAHs. The results indicate that in the post-telemedicine period, patients were 38% less likely to be admitted to the local inpatient facility than to be routinely discharged [aOR=0.62, 95%CI=(0.57,0.67)] after adjusting for age, sex, race, time of visit, clinical diagnosis, CPT code, number of diagnoses, and admitting hospital. The third study addresses cost and efficiency by modeling the financial implications of using the same telemedicine program to avoid transfers and estimating the costs and benefits associated with tele-ED implementation in CAHs. Analysis is based on 9,048 tele-ED encounters generated by the Avera eEmergency program in 85 rural hospitals across seven states between October 2009 and February 2014. For each non-transfer patient, physicians indicated whether the transfer was avoided because of tele-ED activation. The cost-benefit analysis is conducted from the hospital, patient, and societal perspectives, and includes technology costs, local hospital revenues, and patient-associated savings. The results show that 1,175 avoided transfers could be attributed to tele-ED. From a rural hospital perspective, tele-ED costs around $1,739 to avoid a single transfer but saves approximately $5,563 in avoided transportation and indirect patient costs. From a societal perspective, tele-ED results in a net savings of $3,823 per avoided transfer while accounting for tele-ED technology costs, hospital revenues, and patient-associated savings. This study highlights various stakeholder perspectives on the financial impact of tele-ED in avoiding patient transfers in rural EDs. Telemedicine has the potential to reduce the number of transfers of ED patients and generate some revenue for rural hospitals despite associated technology costs, while incurring substantial patient savings.

A centrifugação é o principal método utilizado para fracionar o Sangue Total (ST) nos componentes sanguíneos: Concentrados de Hemácias (CH), Concentrados Plaquetas (CP), Plasma e Crioprecipitado, (também chamados de Hemocomponentes). Com intuito de prevenir ou controlar hemorragias, os CP obtidos por centrifugação tornaram-se o padrão no atendimento inicial aos pacientes com baixas contagens de plaquetas. Porém, para obter uma unidade terapêutica (UT), no Hemocentro RP, é necessário agregar seis CP, formando o Pool de CPST (PCP), o que leva a exposição do receptor a vários doadores diferentes. O CP obtido por aférese (CPAF), advindo de equipamento que permite a seleção já na coleta, fornece a dose necessária em apenas uma doação. Baseado no levantamento de dados internos do Hemocentro de RP o presente estudo analisou, através da metodologia de Custeio Baseado em Atividade (ABC), os custos atribuídos às distintas metodologias para a produção dos CP, sabendo que no Hemocentro RP, os CP são dispensados como UT independente da forma de obtenção. Os resultados obtidos foram utilizados na Análise de Custo-Efetividade, evidenciando que a coleta por Centrifugação de ST com a produção de PCP foi mais custo efetiva em 2015 do que a coleta de aférese, porém, por uma diferença relativamente pequena, devido ao grande percentual de obtenção de dupla Unidade Terapêutica (CPAF2). / Centrifugation is the main method used for fractionating Total Blood (TB) to blood components: Red Cells Concentrate (CR), Platelet Concentrates (PC), Plasma and Cryoprecipitate (also called Hemocomponents). In order to prevent or control bleeding, CPs obtained by centrifugation became the standard treatment of patients with low platelet counts. However, to obtain a therapeutic unit (TU), at Hemocentro RP, it is necessary to get together six PCs, forming a Pool of TBPC (PCP), exposing the receptor to several different donors. PC obtained by apheresis (CPAF), which is provided by a equipment that allows selective collection, achieve the dose necessary for the selection in just one donation. Based on the collection of internal data from the Hemocentro RP, the present study analyzed, through the methodology of ActivityBased Costing (ABC), the costs attributed to the different methodologies for the production of PCs knowing that in the Hemocenter RP PCs are dispensed as TU independent of the way of obtaining. The results obtained were used in the CostEffectiveness Analysis, showing collecting by TB Centrifugation producing PC is more cost-effective, however CPAF was almost as effective as in 2015, a great achievement of Dual Therapeutic Unit in a single donation (CPAF2).