title: The cost-effectiveness of autologous transfusion revisited: implications of an increased risk of bacterial infection with allogeneic transfusion.
abstract: BACKGROUND
  Previous analyses have found autologous transfusion to be very expensive but have not considered avoidance of postoperative bacterial infections as one of its benefits.
  
  
  METHODS
  A cost-utility analysis using 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.
  
  
  RESULTS
  Assuming a base case rate of serious infection of 3.7 percent, a relative risk of infection of 1.85, and additional costs of $12,980 per infection, autologous transfusion has a cost-effectiveness of $2,470 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 2.4, 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 $3,400,000 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 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.
authors.affiliation: Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick 08903, USA. sonnenbe@umdnj.edu
authors.forename: F A
authors.initials: FA
authors.lastname: Sonnenberg
authors.forename: P
authors.initials: P
authors.lastname: Gregory
authors.forename: R
authors.initials: R
authors.lastname: Yomtovian
authors.forename: L B
authors.initials: LB
authors.lastname: Russell
authors.forename: W
authors.initials: W
authors.lastname: Tierney
authors.forename: M
authors.initials: M
authors.lastname: Kosmin
authors.forename: J L
authors.initials: JL
authors.lastname: Carson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D001424:Bacterial Infections / Q000635:transmission; D001804:Blood Transfusion, Autologous / Q000191:economics*; D003362:Cost-Benefit Analysis; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy; D014184:Transplantation, Homologous / Q000009:adverse effects