title: Efficacy and cost-effectiveness of autologous blood predeposit in patients undergoing radical prostatectomy procedures.
abstract: OBJECTIVE
  To assess the efficacy and cost-effectiveness of preoperative autologous blood donation (PAD) in radical prostatectomy procedures.
  
  
  METHODS
  A retrospective 3-year review was performed of transfusion outcomes in radical prostatectomy procedures. Cost, benefits, and cost-effectiveness were established using a previously published Markov decision analysis model.
  
  
  RESULTS
  Three hundred eighty-four (97%) of 394 patients predonated 3.5 +/- 0.6 (mean +/- SD) autologous blood units. Of these, 2.1 +/- 1.2 units (60%) were retransfused. Forty-two (11%) of 394 patients also received allogeneic blood. Autologous blood donors received only 0.2 +/- 0.6 allogeneic blood units, compared with 1.4 +/- 1.4 (p < 0.05) units transfused to patients who did not predonate. The net costs of PAD ranged from $83 to $303 per procedure. The life-expectancy benefit of PAD ranged from 0.05 to 0.07 days. The overall cost-effectiveness of PAD was estimated to be $1,813,000 per quality adjusted life-year saved. However, PAD was significantly more cost-effective for 2 unit donations ($531,000 per quality adjusted life-year saved).
  
  
  CONCLUSIONS
  We conclude that autologous blood donation is an effective blood conservation strategy in elective radical prostatectomy. However, the cost-effectiveness of this practice compares unfavorably with that reported for other medical interventions. Alternative and more cost-effective strategies to reduce the need for allogeneic blood in this setting must be developed.
authors.affiliation: Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: L M
authors.initials: LM
authors.lastname: Goodnough
authors.forename: J E
authors.initials: JE
authors.lastname: Grishaber
authors.forename: J D
authors.initials: JD
authors.lastname: Birkmeyer
authors.forename: T G
authors.initials: TG
authors.lastname: Monk
authors.forename: W J
authors.initials: WJ
authors.lastname: Catalona
mesh_terms: D000368:Aged; D001804:Blood Transfusion, Autologous / Q000191:economics*; D003362:Cost-Benefit Analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000191:economics*; D015397:Program Evaluation; D011468:Prostatectomy / Q000379:methods; D012189:Retrospective Studies