title: The cost-effectiveness of preoperative autologous blood donation for total hip and knee replacement.
abstract: Although the frequency of preoperative autologous blood donation is increasing dramatically, the economic implications of its use remain largely unexplored. Decision analysis was used to calculate the cost-effectiveness of autologous blood donation for hip and knee replacement. Cost-effectiveness, expressed as cost per quality-adjusted year of life saved, was based on observed red cell use in 629 patients undergoing surgery at two tertiary-care centers. Autologous blood donation for bilateral and revision joint replacement cost $40,000 per quality-adjusted year of life saved at Center 1 and $241,000 at Center 2. Autologous blood donation for primary unilateral hip replacement cost $373,000 per quality-adjusted year of life saved at Center 1 and $740,000 at Center 2. Autologous blood donation was least cost-effective for primary unilateral knee replacement ($1,147,000/quality-adjusted year of life saved at Center 1 and $1,467,000/year at Center 2). Differences between autologous blood collections and transfusion requirements explained variations among procedures in the cost-effectiveness of autologous blood donation. Higher transfusion rates in autologous blood donors than in nondonors accounted for the poorer cost-effectiveness of autologous blood donation at Center 2 than at Center 1. Autologous blood donation is not as cost-effective as most accepted medical practices. Its cost-effectiveness can be improved substantially by the avoidance of overcollection and overtransfusion of autologous blood.
authors.affiliation: Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: J D
authors.initials: JD
authors.lastname: Birkmeyer
authors.forename: L T
authors.initials: LT
authors.lastname: Goodnough
authors.forename: J P
authors.initials: JP
authors.lastname: AuBuchon
authors.forename: P G
authors.initials: PG
authors.lastname: Noordsij
authors.forename: B
authors.initials: B
authors.lastname: Littenberg
mesh_terms: D001782:Blood Donors / Q000706:statistics & numerical data*; D001804:Blood Transfusion, Autologous / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D003657:Decision Making; D006622:Hip Prosthesis / Q000191:economics; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D007720:Knee Prosthesis / Q000191:economics; D009513:New Hampshire; D011788:Quality of Life; D026712:Value of Life