title: A decision model and cost analysis of intra-operative cell salvage during hepatic resection.
abstract: Intraoperative cell salvage (ICS) can reduce allogeneic transfusions but with notable direct costs. This study assessed whether routine use of ICS is cost minimizing in hepatectomy and defines a subpopulation of patients where ICS is most cost minimizing based on patient transfusion risk.
  
  
  
  A decision model from a health systems perspective was developed to examine adoption and non-adoption of ICS use for hepatectomy. A prospectively maintained database of hepatectomy patients provided data to populate the model. Probabilistic sensitivity analysis was used to determine the probability of ICS being cost-minimizing at specified transfusion risks. One-way sensitivity analysis was used to identify factors most relevant to institutions considering adoption of ICS for hepatectomies.
  
  
  
  In the base case analysis (transfusion risk of 28.8%) the probability that routine utilization of ICS is cost-minimizing is 64%. The probability that ICS is cost-minimizing exceeds 50% if the patient transfusion risk exceeds 25%. The model was most sensitive to patient transfusion risk, variation in costs of allogeneic blood, and number of appropriate cases the device could be used for.
  
  
  
  ICS is cost-minimizing for routine use in liver resection, particularly when used for patients with a risk of transfusion of 25% or greater.
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Department of Surgery, Sunnybrook Health Sciences Centre, Canada.
authors.forename: Madeline
authors.initials: M
authors.lastname: Lemke
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Centre, Canada.
authors.forename: Gareth
authors.initials: G
authors.lastname: Eeson
authors.affiliation: Department of Clinical Pathology, Sunnybrook Health Sciences Centre, Canada.
authors.forename: Yulia
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Department of Anesthesia, Sunnybrook Health Sciences Centre, Canada.
authors.forename: Jordan
authors.initials: J
authors.lastname: Tarshis
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Centre, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Hallet
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Department of Surgery, Sunnybrook Health Sciences Centre, Canada.
authors.forename: Natalie
authors.initials: N
authors.lastname: Coburn
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Department of Surgery, Sunnybrook Health Sciences Centre, Canada.
authors.forename: Calvin
authors.initials: C
authors.lastname: Law
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Department of Surgery, Sunnybrook Health Sciences Centre, Canada. Electronic address: paul.karanicolas@sunnybrook.ca.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Karanicolas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000191:economics; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D003661:Decision Support Techniques; D005260:Female; D017048:Health Care Costs; D006498:Hepatectomy / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D057725:Operative Blood Salvage / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D011336:Probability; D017064:Process Assessment, Health Care / Q000191:economics*; D018570:Risk Assessment; D012307:Risk Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome; D055815:Young Adult