The cost‐effectiveness of autologous transfusion revisited: implications of an increased risk of bacterialinfection with allogeneic transfusion

Abstract

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 of less than $50,000 per QALY. 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. Until more definitive data are available on the magnitude and costs of this risk, we advise against prematurely closing the debate about the cost-effectiveness of autologous transfusion.

Cost-effectiveness of non-invasive methods for assessment and monitoring of liver fibrosis and cirrhosis in patients with chronic liver disease: systematic review and economic evaluation

“…393,395,396,398-400, [402][403][404][405][406][407][408][409][410] The authors used a similar set of studies to those identified by Shepherd et al 371 and many of the transition probabilities elicited were either identical or similar. The progression from compensated cirrhosis to decompensated cirrhosis was the same for both studies, as Dakin et al 372 used a synthesis of the same papers 396,398,399 used by Shepherd et al…”

Peginterferon alfa and ribavirin for chronic hepatitis C in patients eligible for shortened treatment, re-treatment or in HCV/HIV co-infection: a systematic review and economic evaluation

“…The Schering-Plough model uses a higher excess mortality risk for HCC than is applied in the other models, based on a previously published economic evaluation 99 and cancer mortality statistics. 100 …”

Predeposit autologous donation in spinal surgery: a multicentre study

“…1 Pooled data from the nine medical centres included in this study, regarding the evolution of the use of PABD by patients undergoing spine surgery over the last ten years (1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003) which are not included in the "safety tripod". In fact, there is increasing evidence that TRIM effects of ABT may be responsible for at least a 10% higher rate of postoperative infection in transfused patients, with longer hospital stays [6,25,27,28]. Several studies and clinical observations suggest that AUT might be clinically and immunologically less detrimental than ABT [26].…”

“…However, ABTs are not a risk-free therapy as they carry the potential risk of viral disease transmission, bacterial contamination, incompatibility reactions or transfusion-related immunomodulation (TRIM) [4]. The TRIM effect has been particularly implicated in the increased postoperative infection rate observed in patients who received ABT [6,25,26,27,28].…”

“…However, ABTs are not a risk-free therapy as they carry the potential risk of viral disease transmission, bacterial contamination, incompatibility reactions or transfusion-related immunomodulation (TRIM) [4]. The TRIM effect has been particularly implicated in the increased postoperative infection rate observed in patients who received ABT [6,25,26,27,28].Autologous blood transfusion (AUT) techniques have emerged as the principal means to avoid or reduce the need for ABT. These techniques involve the collection and reinfusion of the patient's own blood by using preoperative autologous blood donation (PABD), preoperative acute normovolaemic haemodilution, intraoperative salAbstract Background.…”