The Role of Autologous Blood Transfusion in Joint Replacement Surgery

Mah, Edward; Davis, Richard W.; Seshadri, P. S.; Nyman, T. L. M.; Seshadri, Ram

doi:10.1177/0310057x9502300411

Cited by 19 publications

(6 citation statements)

References 14 publications

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“…‡ Laupacis et al (1992). § Tretiak et al (1996), Etchason et al (1995), Healy et al (1994), Roberts et al (1996), Mah et al (1995), Monk et al (1995), Scott et al (1992), Solomon et al (1998). ¶ First six above § plus Solomon et al (1988), Elawad et al (1991).…”

Section: Costsmentioning

confidence: 99%

Economic analysis of erythropoietin use in orthopaedic surgery

Coyle

Lee

Fergusson

et al. 1999

Transfusion Medicine

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The aim was to assess the cost-effectiveness of erythropoietin (EPO) to reduce patients' exposure to perioperative allogenic blood products in orthopaedic surgery. The use of EPO was assessed for EPO used alone and for EPO, to augment preoperative autologous donation (PAD). A decision analytical model was designed incorporating (i) the risk of receiving allogeneic blood, (ii) the costs of blood products, (iii) the likelihood of developing transfusion-related diseases, (iv) the costs of transfusion-related diseases, (v) the impact of transfusion-related diseases on patient morbidity and mortality and (vi) the effect of EPO upon the probability of transfusion. The efficacy of EPO was derived from data from a meta-analysis of published randomized trials. Estimates for the other parameters were obtained by a systematic review of the literature. EPO alone led to only modest incremental benefit compared to no intervention for orthopaedic surgery (0.000024 life-years gained per patient). As an augmentation to PAD, EPO also led to modest benefits (0.000006 life-years gained per patient). For EPO compared to no intervention, the incremental cost per life-year gained was $66 million (Canadian). For EPO to augment PAD, the incremental cost per life-year gained was $329 million (Canadian). Detailed sensitivity analysis did not reveal any circumstances in which the cost-effectiveness ratios reached a level generally considered attractive. On the basis of cost-effectiveness, the use of EPO to reduce perioperative allogeneic transfusions in orthopaedic surgery did not meet criteria conventionally considered acceptable.

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Section: Costsmentioning

confidence: 99%

Economic analysis of erythropoietin use in orthopaedic surgery

Coyle

Lee

Fergusson

et al. 1999

Transfusion Medicine

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“…Five studies were found in which different alternatives were combined 36–40 . With one exception, all adopted the hospital perspective (Table 4).…”

Section: Resultsmentioning

confidence: 99%

“…The same holds for the comparison groups. Two studies provided no combined cost‐effectiveness estimate 36,38 . The group of Shulman et al.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies were found in which different alternatives were combined. [36][37][38][39][40] With one exception, all adopted the hospital perspective (Table 4). Apart from this variable, the studies are quite heterogeneous.…”

Section: Combined Strategiesmentioning

confidence: 99%

“…Two studies provided no combined cost-effectiveness estimate. 36,38 The group of Shulman et al 37,39 calculated the costs of one red cell concentrate equivalent for the different methods, but because allogeneic transfusion rates differed, it would have been more interesting to know the cost per allogeneic transfusion avoided. Haynes et al 40 ignored the long-term consequences of allogeneic transfusion completely and concluded that their autologous strategy and allogeneic transfusion were similarly cost-effective with respect to in-hospital mortality, postoperative complications and length of hospital stay.…”

Section: Combined Strategiesmentioning

confidence: 99%

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The cost‐effectiveness of autologous transfusion alternatives: an update and reappraisal

Karger

Kretschmer

2007

Transfus Alt Transfus Med

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SUMMARY There is still an ongoing debate whether autologous transfusion methods (ATM) are cost‐effective when compared with each other or with other medical interventions. A search on MEDLINE and in the British National Health Service Economic Evaluation Database was conducted to retrieve cost‐effectiveness analyses focusing on preoperative autologous blood donation (PABD), acute normovolemic hemodilution (ANH) or perioperative blood salvage (PBS). The search covered the years from 1991 to 2006. The quality of retrieved papers was assessed using published criteria for the evaluation of economic analyses of health‐care measures. Twenty‐six studies were identified: ten for PABD, four for ANH, seven for PBS and five which evaluated strategies combining different ATM. Nineteen studies were conducted in the USA, including most of the PABD studies. Only one study included indirect costs in its cost estimates. The majority of analyses were based on suboptimal study designs. Only six studies employed randomized controlled trials, in most of which avoidance of allogeneic transfusion was chosen as the effectiveness parameter. Ten studies used decision analysis models, calculating cost‐effectiveness ratios based on quality‐adjusted life‐years. These included eight PABD studies and two PBS studies. The assumptions needed for the models were often either outdated or derived from unsystematic reviews of the pertinent literature. In conclusion, economic analyses of ATM are heterogeneous with respect to several aspects of study design. The currently available scientific evidence is of limited quality because of considerable uncertainties in estimates of several key variables thought to substantially affect the results of economic analyses.

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