title: Cost-effectiveness of red blood cell transfusion vs. non-intervention in women with acute anaemia after postpartum haemorrhage.
abstract: BACKGROUND
  Red blood cell (RBC) transfusion is frequently used to treat women with acute anaemia after postpartum haemorrhage. We aimed to assess the economic consequences of red blood cell transfusion compared to non-intervention in these women.
  
  
  METHODS
  A trial-based cost-effectiveness analysis was performed alongside the Well-Being of Obstetric patients on Minimal Blood transfusions (WOMB) trial. Women with acute anaemia [Hb 4·8-7·9 g/dl (3·0-4·9 mm)] after postpartum haemorrhage, without severe anaemic symptoms, were randomly allocated to RBC transfusion or non-intervention. Primary outcome of the trial was physical fatigue (Multidimensional Fatigue Inventory, scale 4-20; 20 represents maximal fatigue). Total costs per arm were calculated using a hospital perspective with a 6 weeks time horizon.
  
  
  RESULTS
  Per woman, mean costs in the RBC transfusion arm (n = 258) were €1957 compared to €1708 in the non-intervention arm (n = 261; P = 0·024). The 13% difference in costs between study arms predominantly originated from costs of RBC units, as costs of RBC units were six times higher in the RBC transfusion arm. RBC transfusion led to a small improvement in physical fatigue of 0·58 points per day; thus, the costs to improve the physical fatigue score with one point would be €431.
  
  
  CONCLUSIONS
  In women with acute anaemia after postpartum haemorrhage (PPH), RBC transfusion is on average €249 more expensive per woman than non-intervention, with only a small gain in HRQoL after RBC transfusion. Taking both clinical and economic consequences into account, implementation of a non-intervention policy seems justified.
authors.affiliation: Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, the Netherlands; Department of Obstetrics and Gynaecology, Maasstad Hospital, Rotterdam, the Netherlands.
authors.forename: B W
authors.initials: BW
authors.lastname: Prick
authors.forename: J J
authors.initials: JJ
authors.lastname: Duvekot
authors.forename: P E
authors.initials: PE
authors.lastname: van der Moer
authors.forename: N
authors.initials: N
authors.lastname: van Gemund
authors.forename: P C M
authors.initials: PC
authors.lastname: van der Salm
authors.forename: A J G
authors.initials: AJ
authors.lastname: Jansen
authors.forename: D J
authors.initials: DJ
authors.lastname: van Rhenen
authors.forename: B W
authors.initials: BW
authors.lastname: Mol
authors.forename: C A
authors.initials: CA
authors.lastname: Uyl-de Groot
mesh_terms: D000328:Adult; D000740:Anemia / Q000191:economics / Q000209:etiology / Q000628:therapy*; D003362:Cost-Benefit Analysis; D017707:Erythrocyte Transfusion; D005221:Fatigue; D005260:Female; D006761:Hospitals; D006801:Humans; D006473:Postpartum Hemorrhage / Q000175:diagnosis*; D049590:Postpartum Period; D011247:Pregnancy; D011788:Quality of Life; D012720:Severity of Illness Index
keywords: anaemia; cost-effectiveness; obstetric complication; postpartum haemorrhage; transfusion