Effectiveness of Iron Supplementation With or Without Erythropoiesis-Stimulating Agents on Red Blood Cell Utilization in Patients With Preoperative Anaemia Undergoing Elective Surgery: A Systematic Review and Meta-Analysis

Laermans, Jorien; Avau, Bert; Bekkering, Geertruida E; Georgsen, Jørgen; Manzini, Paola; Meybohm, Patrick; Ozier, Yves; Buck, Emmy De; Compernolle, Veerle; Vandekerckhove, Philippe

doi:10.1016/j.tmrv.2021.03.004

Cited by 8 publications

(13 citation statements)

References 43 publications

(13 reference statements)

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“…In contrast, the reduction in costs associated with blood transfusion are the main drivers of the cost savings reported by Froessler et al and Trentino et al [28][29][30]. However, given the uncertainty regarding the effectiveness of preoperative IV iron for anaemia correction [10], any conclusion regarding cost effectiveness remains speculative.…”

Section: Discussionmentioning

confidence: 99%

“…The effectiveness and undesirable effects of erythropoietin (EPO) and/or iron therapy have been investigated by our team in separate systematic reviews ( [10] and submitted for publication). These concluded that intravenous or oral iron therapy may not reduce the number of patients transfused [10]. Furthermore, ESAs combined with iron therapy probably reduce the number of patients transfused.…”

Section: Key Points For Decision Makersmentioning

confidence: 99%

“…Identified economic evaluations with a lifetime time horizon on the cost effectiveness of EPO and iron [13,14] were updated with recent cost and effectiveness data. Updated clinical effectiveness data, proportion of patients transfused and number of allogeneic blood units transfused, were based on a systematic review that was a part of the same project as the current review [10]. Current cost data regarding EPO, iron and allogeneic blood products were based on market prices obtained through multi-country surveys (Online Resource 4, see ESM).…”

Section: Additional Sensitivity Analysesmentioning

confidence: 99%

“…A source of uncertainty regarding the identified data is that the studies with a lifetime time horizon were conducted over a decade ago [13,14]. Therefore, we updated the analyses with more recent data regarding the effects of EPO+iron treatment on utilization of blood products [10] and costs of EPO, iron and blood products (Online Resource 4, see ESM).…”

Section: Sensitivity Analysesmentioning

confidence: 99%

“…These data were then adapted to the Scottish context by using data on country level, from NHS Scotland. This seems to be appropriate Utilities were derived from published literature and subject to sensitivity analyses Uncertainty of the model was assessed using up to seven scenario analyses of extreme adaptations of the base case, which take into account all potentially important parameters Analysis 3: Updated effectiveness data from systematic review [10] and cost data based on Tomeczkowski et al [15] (quality-adjusted) LY gained of several millions in the most realistic scenario according to the study authors. Importantly, these economic evaluations focused on transfusionrelated adverse events, and did not take into account any potential adverse events of EPO nor iron treatment, making these estimates conservative.…”

Section: Consistency • Internal Consistency • External Consistencymentioning

confidence: 99%

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Lack of Cost-Effectiveness of Preoperative Erythropoiesis-Stimulating Agents and/or Iron Therapy in Anaemic, Elective Surgery Patients: A Systematic Review and Updated Analysis

Avau¹,

Remoortel²,

Laermans³

et al. 2021

PharmacoEconomics

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Objectives For anaemic elective surgery patients, current clinical practice guidelines weakly recommend the routine use of iron, but not erythrocyte-stimulating agents (ESAs), except for short-acting ESAs in major orthopaedic surgery. This recommendation is, however, not based on any cost-effectiveness studies. The aim of this research was to (1) systematically review the literature regarding cost effectiveness of preoperative iron and/or ESAs in anaemic, elective surgery patients and (2) update existing economic evaluations (EEs) with recent data. Methods Eight databases and registries were searched for EEs and randomized controlled trials (RCTs) reporting cost-effectiveness data on November 11, 2020. Data were extracted, narratively synthesized and critically appraised using the Philips reporting checklist. Pre-existing full EEs were updated with effectiveness data from a recent systematic review and current cost data. Incremental cost-effectiveness ratios were expressed as cost per (quality-adjusted) life-year [(QA)LY] gained. Results Only five studies (4 EEs and 1 RCT) were included, one on intravenous iron and four on ESAs + oral iron. The EE on intravenous iron only had an in-hospital time horizon. Therefore, cost effectiveness of preoperative iron remains uncertain. The three EEs on ESAs had a lifetime time horizon, but reported cost per (QA)LY gained of 20-65 million (GBP or CAD). Updating these analyses with current data confirmed ESAs to have a cost per (QA)LY gained of 3.5-120 million (GBP or CAD). Conclusions Cost effectiveness of preoperative iron is unproven, whereas routine preoperative ESA therapy cannot be considered cost effective in elective surgery, based on the limited available data. Future guidelines should reflect these findings.

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Effectiveness of Iron Supplementation With or Without Erythropoiesis-Stimulating Agents on Red Blood Cell Utilization in Patients With Preoperative Anaemia Undergoing Elective Surgery: A Systematic Review and Meta-Analysis

Cited by 8 publications

References 43 publications

Lack of Cost-Effectiveness of Preoperative Erythropoiesis-Stimulating Agents and/or Iron Therapy in Anaemic, Elective Surgery Patients: A Systematic Review and Updated Analysis

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