title: Cost savings of red cell salvage during cesarean delivery.
abstract: OBJECTIVE
  To use decision analysis to evaluate whether and under what conditions routine setup of intraoperative cell salvage during cesarean delivery is cost-saving.
  
  
  METHODS
  We developed a decision model to compare costs associated with two strategies for cesarean delivery: 1) routine setup of intraoperative cell salvage; or 2) standard care without intraoperative cell salvage. One-, two-, and three-way sensitivity analyses as well as Monte Carlo simulation were used to assess the robustness of our findings.
  
  
  RESULTS
  Among nonselected women undergoing cesarean delivery, our base case estimate was that 3.2% would require red blood cell transfusion. Under this assumption, cell salvage is cost-saving only if each woman requires at least 60 units. Conversely, if only two units on average are required, the probability of transfusion needs to be at least 58% for cell salvage to be cost-saving. In our base case analysis, setup of intraoperative cell salvage during routine cesarean deliveries is not cost-saving, increasing the cost per cesarean delivery by $223.80. We found that cell salvage would be cost-saving only in very high-risk scenarios. For example, severe maternal anemia or abnormal placentation, in which 54% and 75% of women are transfused three and two units per case, respectively, would make cell salvage cost-saving.
  
  
  CONCLUSIONS
  Setup of intraoperative cell salvage during cesarean delivery is cost-saving and should be considered only when there is a predictably high probability of transfusion or when a massive transfusion is reasonably likely.
authors.affiliation: Division of Maternal Fetal Medicine, Women and Infants Hospital, the Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Albright
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
authors.forename: Erika F
authors.initials: EF
authors.lastname: Werner
mesh_terms: D000328:Adult; D001804:Blood Transfusion, Autologous / Q000191:economics / Q000379:methods; D002585:Cesarean Section / Q000191:economics* / Q000379:methods*; D015331:Cohort Studies; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D017707:Erythrocyte Transfusion / Q000191:economics* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D009010:Monte Carlo Method; D057725:Operative Blood Salvage / Q000191:economics* / Q000379:methods; D011247:Pregnancy; D018570:Risk Assessment; D016896:Treatment Outcome