Cost effectiveness of epoetin-alpha to augment preoperative autologous blood donation in elective cardiac surgery.
OBJECTIVE
The objective of this study was to assess the cost effectiveness of using epoetin-alpha (erythropoietin) to augment preoperative autologous donation (PAD) of blood prior to elective cardiac surgery.


METHODS
We designed a decision-analytic model incorporating the risk of receiving allogeneic blood, the costs of blood products, the likelihood of developing transfusion-related diseases, the costs of transfusion-related diseases and their impact on life expectancy, and the effect of epoetin-alpha on the probability of transfusion.


METHODS
The efficacy of epoetin-alpha was derived from data from a meta-analysis of published randomised trials comparing the use of epoetin-alpha to augment PAD with the use of PAD alone. Estimates for the other parameters were obtained by a systematic review of the literature.


RESULTS
The use of epoetin-alpha reduced the proportion of patients receiving allogeneic transfusions by 60% (from 31.6 to 12.7%). However, this led to only a modest benefit of 0.000035 life years gained per patient and an incremental cost per life year gained of $Can44.6 million (1998 Canadian dollars). A detailed sensitivity analysis confirmed that the cost-effectiveness ratio was larger than that which is generally considered acceptable.


CONCLUSIONS
Our study indicates that the use of epoetin-alpha to reduce perioperative allogeneic transfusions in cardiac surgery is not cost effective.
Coyle
D
D
Clinical Epidemiology Unit, Loeb Health Research Institute, Ottawa Hospital, Canada. dcoyle@lri.ca
Lee
K M
KM
Fergusson
D A
DA
Laupacis
A
A
D001804:Blood Transfusion, Autologous / Q000191:economics*; D006348:Cardiac Surgical Procedures; D003362:Cost-Benefit Analysis; D004921:Erythropoietin / Q000627:therapeutic use*; D006801:Humans
D004921:Erythropoietin