title: Potential cost saving of Epoetin alfa in elective hip or knee surgery due to reduction in blood transfusions and their side effects: a discrete-event simulation model.
abstract: OBJECTIVE
  Transfusion of allogeneic blood is still common in orthopedic surgery. This analysis evaluates from the perspective of a German hospital the potential cost savings of Epoetin alfa (EPO) compared to predonated autologous blood transfusions or to a nobloodconservationstrategy (allogeneic blood transfusion strategy)during elective hip and knee replacement surgery.
  
  
  METHODS
  Individual patients (N = 50,000) were simulated based on data from controlled trials, the German DRG institute (InEK) and various publications and entered into a stochastic model (Monte-Carlo) of three treatment arms: EPO, preoperative autologous donation and nobloodconservationstrategy. All three strategies lead to a different risk for an allogeneic blood transfusion. The model focused on the costs and events of the three different procedures. The costs were obtained from clinical trial databases, the German DRG system, patient records and medical publications: transfusion (allogeneic red blood cells: €320/unit and autologous red blood cells: €250/unit), pneumonia treatment (€5,000), and length of stay (€300/day). Probabilistic sensitivity analyses were performed to determine which factors had an influence on the model's clinical and cost outcomes.
  
  
  RESULTS
  At acquisition costs of €200/40,000 IU EPO is cost saving compared to autologous blood donation, and cost-effective compared to a nobloodconservationstrategy. The results were most sensitive to the cost of EPO, blood units and hospital days.
  
  
  CONCLUSIONS
  EPO might become an attractive blood conservation strategy for anemic patients at reasonable costs due to the reduction in allogeneic blood transfusions, in the modeled incidence of transfusion-associated pneumonia andthe prolongedlength of stay.
authors.affiliation: Department of Health Economics, Janssen-Cilag GmbH, Neuss, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Tomeczkowski
authors.forename: Sean
authors.initials: S
authors.lastname: Stern
authors.forename: Alfred
authors.initials: A
authors.lastname: Müller
authors.forename: Christian
authors.initials: C
authors.lastname: von Heymann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001803:Blood Transfusion / Q000191:economics*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D006295:Health Resources; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009985:Orthopedics / Q000191:economics; D011994:Recombinant Proteins / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D065227:Transfusion Reaction
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa
references.citation: Br J Anaesth. 2012 Jun;108(6):943-52
references.pmid: 22593128
references.citation: Anesth Analg. 2005 May;100(5):1416-1421
references.pmid: 15845698
references.citation: Z Orthop Ihre Grenzgeb. 2004 Nov-Dec;142(6):673-8
references.pmid: 15614646
references.citation: Transfusion. 2008 Feb;48(2):237-50
references.pmid: 18005329
references.citation: Adv Orthop. 2012;2012:595027
references.pmid: 22811922
references.citation: Orthopade. 2011 Nov;40(11):1018-20, 1023-5, 1027-8
references.pmid: 21922268
references.citation: Orthopedics. 1999 Jan;22(1 Suppl):s105-12
references.pmid: 9927110
references.citation: Transfusion. 2012 Sep;52(9):1983-8
references.pmid: 22313531
references.citation: Transfus Med Rev. 2002 Jul;16(3):187-99
references.pmid: 12075558
references.citation: Transfus Med. 2001 Apr;11(2):87-95
references.pmid: 11299025
references.citation: Br J Anaesth. 2011 Jan;106(1):13-22
references.pmid: 21148637
references.citation: Anesthesiology. 2009 Mar;110(3):574-81
references.pmid: 19212255
references.citation: Ann Intern Med. 2012 Jul 3;157(1):49-58
references.pmid: 22751760
references.citation: Transfus Med Hemother. 2010 Jun;37(3):141-148
references.pmid: 20737017
references.citation: Transfusion. 2010 Apr;50(4):753-65
references.pmid: 20003061
references.citation: Arthritis Care Res. 1995 Sep;8(3):167-73
references.pmid: 7654801
references.citation: Ann Intern Med. 2000 Dec 5;133(11):845-54
references.pmid: 11103054
references.citation: Anesthesiology. 2012 Dec;117(6):1175-83
references.pmid: 23090146
references.citation: Br J Anaesth. 2007 Dec;99(6):794-800
references.pmid: 17928302
references.citation: Transfus Med. 1999 Mar;9(1):21-30
references.pmid: 10216902
references.citation: J Bone Joint Surg Am. 2004 Jul;86(7):1512-8
references.pmid: 15252101
references.citation: Can J Anaesth. 2005 Apr;52(4):347-51
references.pmid: 15814746
references.citation: Ann Thorac Surg. 2011 Jun;91(6):1674-80; discussion 1680
references.pmid: 21514923
references.citation: Blood. 2011 Dec 15;118(25):6675-82
references.pmid: 22021369
references.citation: Asian J Transfus Sci. 2010 Jul;4(2):78-85
references.pmid: 20859504
references.citation: J Arthroplasty. 2013 Oct;28(9):1463-72
references.pmid: 23528548
references.citation: Transfusion. 2007 May;47(5):832-41
references.pmid: 17465948
references.citation: J Arthroplasty. 2010 Jan;25(1):93-6
references.pmid: 19056224
references.citation: Cochrane Database Syst Rev. 2002;(2):CD003602
references.pmid: 12076491
references.citation: Blood Transfus. 2012 Jul;10(3):247-51
references.pmid: 22889813
references.citation: Clin Orthop Relat Res. 2004 Jun;(423):240-4
references.pmid: 15232456
references.citation: J Am Coll Surg. 2009 May;208(5):931-7, 937.e1-2; discussion 938-9
references.pmid: 19476865
references.citation: Vox Sang. 2009 Jan;96(1):1-13
references.pmid: 19121192
references.citation: Open Orthop J. 2012;6:179-83
references.pmid: 22629289
references.citation: Transfusion. 2011 Apr;51(4):702-9
references.pmid: 20849411
references.citation: Transfusion. 2001 Jul;41(7):957-63
references.pmid: 11452166
references.citation: Eur J Anaesthesiol. 2005 Apr;22(4):249-57
references.pmid: 15892401
references.citation: Clin Orthop Relat Res. 1998 Dec;(357):82-8
references.pmid: 9917704
references.citation: BMC Musculoskelet Disord. 2009 Dec 29;10:167
references.pmid: 20040083
references.citation: Health Technol Assess. 2006 Nov;10(44):iii-iv, ix-x, 1-210
references.pmid: 17049141
references.citation: Transfusion. 2003 Apr;43(4):459-69
references.pmid: 12662278
references.citation: Anesthesiology. 2008 Dec;109(6):951-3
references.pmid: 19034088
references.citation: Vox Sang. 2011 Jan;100(1):10-21
references.pmid: 21175652
references.citation: J Orthop Traumatol. 2010 Sep;11(3):159-65
references.pmid: 20835744
references.citation: Transfusion. 2010 Nov;50(11):2455-60
references.pmid: 20529000
references.citation: Anesth Analg. 2004 Oct;99(4):1239-1244
references.pmid: 15385383
references.citation: Can J Anaesth. 2005 Feb;52(2):160-5
references.pmid: 15684256
references.citation: Acta Orthop. 2006 Aug;77(4):677-83
references.pmid: 16929448