Erythropoietin and preoperative autologous blood donation in the prevention of hepatitis C infection: necessity or luxury?
BACKGROUND
Prevention of exposure to allogeneic blood transfusion during surgery is an important financial issue when recombinant human erythropoietin (rHuEPO) is used in addition to preoperative blood donation.


METHODS
The aim of this study was to carry out a cost-effectiveness analysis of the use of rHuEPO in preoperative blood donation in orthopedic surgery. The study, based on a decision tree analysis of the use of rHuEPO, was conducted from the perspective of the French health care system. The efficacy criterion was the number of hepatitis C infections prevented. The decision tree analysis was constructed as follows: the residual risk of hepatitis C infection was 8.26 per million units transfused, and the chance node was defined according to the number of units transfused.


RESULTS
With the use of rHuEPO in preoperative blood donation, 0.30562 cases of hepatitis C infection per 100,000 patients were prevented. The incremental cost of one prevented hepatitis C infection amounted to $888,000,000 (US).


CONCLUSIONS
Despite the limitations of our model, the cost-effectiveness ratio was so large that variations only slightly modified the size of the result. From the societal perspective, it was not cost-effective to add rHuEPO to preoperative blood donation.
Woronoff-Lemsi
M C
MC
Department of Pharmacy, the Doubs Caner Registry, Beasançon University Hospital, France. marie-christin.woronoff@ufc-chi.univ-fcomte.fr
Arveux
P
P
Limat
S
S
Morel
P
P
Le Pen
C
C
Cahn
J Y
JY
D001782:Blood Donors; D001804:Blood Transfusion, Autologous / Q000191:economics; D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D004921:Erythropoietin / Q000627:therapeutic use*; D006526:Hepatitis C / Q000517:prevention & control*; D006801:Humans; D011300:Preoperative Care; D011994:Recombinant Proteins; D012680:Sensitivity and Specificity
D011994:Recombinant Proteins; D004921:Erythropoietin