A Health Economic Analysis of Autologous Transfusion

Publisher： Karger

E-ISSN： 1660-3818|29|3|175-183

ISSN： 1660-3796

Source： Transfusion Medicine and Hemotherapy, Vol.29, Iss.3, 2002-07, pp. : 175-183

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Abstract

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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