title: Economic evaluation alongside the Premature Infants in Need of Transfusion randomised controlled trial.
abstract: BACKGROUND
  The Premature Infants in Need of Transfusion (PINT) Outcome Study showed no significant difference in the primary outcome of death or neurodevelopmental impairment (NDI) in extremely low birthweight (ELBW) infants. However, a post-hoc analysis expanding the definition of NDI to include borderline intellectual functioning (Mental Development Index (MDI) <85) found an improvement in outcomes in the group maintained at higher haemoglobin levels.
  
  
  OBJECTIVE
  To determine the cost effectiveness of more frequent red blood cell transfusions (high-Hb threshold) compared with less frequent transfusions (low-Hb threshold) in ELBW infants.
  
  
  METHODS
  The authors performed an economic evaluation using patient-level data collected during the PINT randomised trial. The authors measured comprehensive costs from a third-party payer's perspective over a time horizon from birth through 18-21 months corrected age.
  
  
  RESULTS
  The average total cost in the high-Hb threshold group was CAN$149 767 compared with CAN$150 227 in the low-Hb threshold group (difference of CAN$460, p=0.96). Cost-effectiveness analysis estimated savings of CAN$6879 for every additional infant surviving without severe NDI. There was a 48% chance that the high-Hb threshold reduced costs while improving outcome and a 90% chance that it would be cost effective at a willingness-to-pay threshold of CAN$250 000 per additional survivor without severe NDI. Post-hoc analysis defining cognitive delay as MDI score <85, instead of <70, revealed savings in the high-Hb threshold group of CAN$4457 per additional survivor without NDI. Results were robust to deterministic sensitivity analyses.
  
  
  CONCLUSIONS
  A high-Hb threshold for transfusion, as measured in ELBW PINT study infants through 18 months corrected gestational age, may be an economically appealing intervention. The estimates were associated with moderate statistical uncertainty that should be targeted in larger, future studies.
authors: Division of Neonatology, Boston Medical Center, 771 Albany Street, Boston, MA 02118, USA. karen.kamholz@bmc.org
authors: Karen L
authors: KL
authors: Kamholz
authors: Dmitry
authors: D
authors: Dukhovny
authors: Haresh
authors: H
authors: Kirpalani
authors: Robin K
authors: RK
authors: Whyte
authors: Robin S
authors: RS
authors: Roberts
authors: Na
authors: N
authors: Wang
authors: WenYang
authors: W
authors: Mao
authors: John A F
authors: JA
authors: Zupancic
mesh_terms: D000751:Anemia, Neonatal / Q000097:blood / Q000191:economics* / Q000523:psychology / Q000628:therapy; D001315:Australia; D001724:Birth Weight; D002170:Canada; D003072:Cognition Disorders / Q000191:economics / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D002658:Developmental Disabilities / Q000191:economics* / Q000517:prevention & control; D017707:Erythrocyte Transfusion / Q000191:economics* / Q000379:methods; D017048:Health Care Costs / Q000706:statistics & numerical data; D006295:Health Resources / Q000706:statistics & numerical data; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000097:blood / Q000191:economics* / Q000523:psychology / Q000628:therapy; D015931:Intensive Care, Neonatal / Q000191:economics / Q000379:methods; D014481:United States
chemical_list: D006454:Hemoglobins