A cost analysis of autologous and allogeneic transfusions in hip-replacement surgery

Blumberg, Neil; Kirkley, Scott A.; Heal, Joanna M.

doi:10.1016/s0002-9610(97)89635-3

Cited by 100 publications

(80 citation statements)

References 17 publications

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“…Some professional organizations in the United States, such as the American Association of Blood Banks and the American Medical Association have made formal recommendations that autologous transfusion be encouraged when clinically applicable. At least two states, California and New Jersey, have mandated that physicians discuss the option of autologous blood donation prior to elective surgery [1]. However, highly accurate tests for diagnosing blood-borne infections, particularly HIV-1 and -2 and hepatitis C, have been introduced into routine use.…”

Section: Introductionmentioning

confidence: 99%

A Health Economic Analysis of Autologous Transfusion

Sonnenberg¹

2002

Transfus Med Hemother

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Background: Autologous transfusion reduces the risk of bloodborne viral infections and may decrease the risk of postoperative infections related to immunomodulation. Previous analyses have shown autologous transfusion to be expensive. Methods: A previously published cost-utility analysis was updated. A Markov cohort simulation model compared autologous blood transfusion to allogeneic transfusion in a hypothetical cohort of patients undergoing elective total hip replacement with respect to discounted quality-adjusted life years (QALYs) and health care system costs. Costs were updated to Year 2000 dollars and a new model of HIV infection, reflecting contemporary treatment was included. Results: Assuming a base case rate of serious postoperative infection of 3.7%, a relative risk of infection of 1.85, and additional costs of $14,490 per infection, autologous transfusion costs $144 more per patient and results in a gain of 0.0523 QALYs; a cost-effectiveness of $2,750 per QALY. If the relative risk of bacterial infection following allogeneic transfusion exceeds 1.1, the cost-effectiveness of autologous transfusion is less than $50,000 per QALY and if the relative risk exceeds 2.39, autologous transfusion is dominant, resulting in both lower costs and greater QALYs. If there were no increased risk of transfusion, the cost-effectiveness of autologous transfusion would be $2,548,000 per QALY. Conclusions: If there is only a modest increase in the risk of bacterial infection following allogeneic transfusion, autologous transfusion would result in improved outcomes at a cost-effectiveness that compares favorably to well-accepted health interventions. Autologous transfusion would be dominant above a relative risk of infection that is within the range of values observed in randomized controlled trials. However, if there is no increased risk of bacterial infection, autologous transfusion would be a very expensive strategy.

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Section: Introductionmentioning

confidence: 99%

A Health Economic Analysis of Autologous Transfusion

Sonnenberg¹

2002

Transfus Med Hemother

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“…23 For example, a review of the economic analyses of PAD shows that the cost-effectiveness estimates for PAD are also clearly unfavourable when these healtheffects are not included in the analysis, [24][25][26] but once they are included, the estimates become favourable. [27][28][29] In addition, PET, by increasing Hb concentration throughout the hospital stay, may improve functional recovery as has been demonstrated in patients undergoing surgery for hip fracture. 30,31 Moreover, the economic analysis of PET also did not account for the substantial cost-effectiveness improvements that can be achieved by modifying the dosing schedule or by improving patient selection criteria such that PET is offered only to those patients who are at high-risk of requiring RBC transfusion.…”

Section: Discussionmentioning

confidence: 99%

Erythropoietin is an effective clinical modality for reducing RBC transfusion in joint surgery

Karkouti

McCluskey

Evans

et al. 2005

Can J Anesth/J Can Anesth

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“…26 The use of autologous transfusion for elective surgical patients increased dramatically during the 1980s and 1990s in an effort to minimize the risk of viral infection from allogeneic transfusion. While not directly addressing the issue of the cost-effectiveness of leukoreduction, this study is of interest because during the 1990s, a number of randomized trials (four of five between 1993 and 2001) demonstrated that autologous transfusion was associated with reduced morbidity compared to allogeneic transfusion.…”

Section: Cost-efficacy Issues (Table 2)mentioning

confidence: 99%