The cost-effectiveness of postoperative recovery of RBCs in preventing transfusion-associated virus transmission after joint arthroplasty.
BACKGROUND
The return of joint drainage after hip and knee arthroplasty is a widely used but expensive blood-conservation technique.


METHODS
A Markov decision analysis model was used to evaluate the cost-effectiveness of postoperative RBC recovery in preventing viral complications of allogeneic transfusion.


RESULTS
In the baseline analysis, using an RBC-recovery device saves 5 quality-adjusted minutes of longevity at an average incremental cost of $53. This corresponds to $5.7 million per quality-adjusted life year. This figure was most sensitive to the direct cost differences of allogeneic versus recovered RBCs and to the volume of RBCs recovered per device. Such devices would save health care resources if they cost less than $73 or if they were applied only in cases where joint drainage was between 600 and 1100 mL.


CONCLUSIONS
For most clinical situations, postarthroplasty RBC recovery does not appear to be as cost-effective as most other medical interventions. Clinical attention should be directed toward developing protocols for the preferential use of postoperative RBC-recovery devices in situations where they provide the greatest benefit.
Jackson
B R
BR
Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
Umlas
J
J
AuBuchon
J P
JP
D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D003362:Cost-Benefit Analysis; D004912:Erythrocytes / Q000502:physiology*; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D011182:Postoperative Care / Q000191:economics*; D011788:Quality of Life; D020127:Recovery of Function / Q000502:physiology; D013997:Time Factors; D065227:Transfusion Reaction