title: Cost-effectiveness analysis of preoperative transfusion in patients with sickle cell disease using evidence from the TAPS trial.
abstract: The study's objective was to assess the cost-effectiveness of preoperative transfusion compared with no preoperative transfusion in patients with sickle cell disease undergoing low- or medium-risk surgery. Seventy patients with sickle cell disease (HbSS/Sß(0) thal genotypes) undergoing elective surgery participated in a multicentre randomised trial, Transfusion Alternatives Preoperatively in Sickle Cell Disease (TAPS). Here, a cost-effectiveness analysis based on evidence from that trial is presented. A decision-analytic model is used to incorporate long-term consequences of transfusions and acute chest syndrome. Costs and health benefits, expressed as quality-adjusted life years (QALYs), are reported from the 'within-trial' analysis and for the decision-analytic model. The probability of cost-effectiveness for each form of management is calculated taking into account the small sample size and other sources of uncertainty. In the range of scenarios considered in the analysis, preoperative transfusion was more effective, with the mean improvement in QALYs ranging from 0.018 to 0.206 per patient, and also less costly in all but one scenario, with the mean cost difference ranging from -£813 to £26. All scenarios suggested preoperative transfusion had a probability of cost-effectiveness >0.79 at a cost-effectiveness threshold of £20 000 per QALY.
authors: Centre for Health Economics, University of York, York, UK.
authors: Eldon
authors: E
authors: Spackman
authors: Mark
authors: M
authors: Sculpher
authors: Jo
authors: J
authors: Howard
authors: Moira
authors: M
authors: Malfroy
authors: Charlotte
authors: C
authors: Llewelyn
authors: Louise
authors: L
authors: Choo
authors: Renate
authors: R
authors: Hodge
authors: Tony
authors: T
authors: Johnson
authors: David C
authors: DC
authors: Rees
authors: Karin
authors: K
authors: Fijnvandraat
authors: Melanie
authors: M
authors: Kirby-Allen
authors: Sally
authors: S
authors: Davies
authors: Lorna
authors: L
authors: Williamson
mesh_terms: D000368:Aged; D000465:Algorithms; D000755:Anemia, Sickle Cell / Q000191:economics* / Q000628:therapy*; D001803:Blood Transfusion / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
keywords: Transfusion Alternatives Preoperatively in Sickle Cell Disease trial; cost; cost-effectiveness; quality-adjusted life years; sickle cell disease; transfusion