title: Economic evaluation of a randomized clinical trial of haemodilution with cell salvage in aortic surgery.
abstract: BACKGROUND
  This study evaluated the costs of acute normovolaemic haemodilution (ANH) and intraoperative cell salvage (ICS) versus homologous blood transfusion in aortic surgery in a prospective multicentre randomized trial.
  
  
  METHODS
  One hundred and forty-five patients were randomized either to standard transfusion practice (homologous) or to a combination of ANH and ICS (autologous). Costs for each inpatient admission were identified. Cell salvage costs were assigned on the assumption that 50 operations were done each year employing a trained cell salvage operator. The results were analysed statistically using bias-corrected bootstrap analysis.
  
  
  RESULTS
  Patients who had transfusion of homologous blood received some 251 units and those having a homologous transfusion received 103 units (P = 0.008). There was no difference in morbidity, mortality and duration of hospital stay. Transfusion-related mean costs were similar at 340 UK pounds for patients having a homologous transfusion and 357 UK pounds for those receiving autologous blood (mean difference 17 UK pounds (95 per cent confidence interval [c.i.]--184 UK pounds to 174 UK pounds); P not significant). There was also no significant difference in mean overall costs: 5859 UK pounds for homologous and 5384 UK pounds for autologous transfusion (mean difference--475 UK pounds (95 per cent c.i.--2231 UK pounds to 1342 UK pounds)). Sensitivity analysis showed that costs remained similar for 20 and 150 operations per annum. Exclusion of a dedicated cell salvage operator reduced autologous transfusion costs but did not have a significant impact on overall cost.
  
  
  CONCLUSIONS
  Autologous transfusion is cost neutral in aortic surgery even when surgical activity is low.
authors.affiliation: Academic Surgery Unit, South Manchester University Hospital, Wythenshawe, Manchester, M23 9LT, UK. S_Haynes@fs1.with.man.ac.uk
authors.forename: S L
authors.initials: SL
authors.lastname: Haynes
authors.forename: F
authors.initials: F
authors.lastname: Torella
authors.forename: J C L
authors.initials: JC
authors.lastname: Wong
authors.forename: K
authors.initials: K
authors.lastname: Dalrymple
authors.forename: M
authors.initials: M
authors.lastname: James
authors.forename: C N
authors.initials: CN
authors.lastname: McCollum
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001014:Aortic Aneurysm / Q000601:surgery*; D001804:Blood Transfusion, Autologous; D003362:Cost-Benefit Analysis; D006438:Hemodilution / Q000191:economics* / Q000379:methods; D006801:Humans; D007430:Intraoperative Care / Q000191:economics* / Q000379:methods; D007902:Length of Stay; D008875:Middle Aged; D011446:Prospective Studies; D016879:Salvage Therapy / Q000191:economics / Q000379:methods; D012680:Sensitivity and Specificity