title: Are lower levels of red blood cell transfusion more cost-effective than liberal levels after cardiac surgery? Findings from the TITRe2 randomised controlled trial.
abstract: To assess the incremental cost and cost-effectiveness of a restrictive versus a liberal red blood cell transfusion threshold after cardiac surgery.
  
  
  
  A within-trial cost-effectiveness analysis with a 3-month time horizon, based on a multicentre superiority randomised controlled trial from the perspective of the National Health Service (NHS) and personal social services in the UK.
  
  
  
  17 specialist cardiac surgery centres in UK NHS hospitals.
  
  
  
  2003 patients aged >16 years undergoing non-emergency cardiac surgery with a postoperative haemoglobin of <9 g/dL.
  
  
  
  Restrictive (transfuse if haemoglobin <7.5 g/dL) or liberal (transfuse if haemoglobin <9 g/dL) threshold during hospitalisation after surgery.
  
  
  
  Health-related quality of life measured using the EQ-5D-3L to calculate quality-adjusted life years (QALYs).
  
  
  
  The total costs from surgery up to 3 months were £17 945 and £18 127 in the restrictive and liberal groups (mean difference is -£182, 95% CI -£1108 to £744). The cost difference was largely attributable to the difference in the cost of red blood cells. Mean QALYs to 3 months were 0.18 in both groups (restrictive minus liberal difference is 0.0004, 95% CI -0.0037 to 0.0045). The point estimate for the base-case cost-effectiveness analysis suggested that the restrictive group was slightly more effective and slightly less costly than the liberal group and, therefore, cost-effective. However, there is great uncertainty around these results partly due to the negligible differences in QALYs gained.
  
  
  
  We conclude that there is no clear difference in the cost-effectiveness of restrictive and liberal thresholds for red blood cell transfusion after cardiac surgery.
  
  
  
  ISRCTN70923932; Results.
authors.affiliation: Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK.
authors.forename: E A
authors.initials: EA
authors.lastname: Stokes
authors.affiliation: Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK.
authors.forename: S
authors.initials: S
authors.lastname: Wordsworth
authors.affiliation: Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK Eli Lilly and Company Limited, Lilly House, Basingstoke, Hampshire, UK.
authors.forename: D
authors.initials: D
authors.lastname: Bargo
authors.affiliation: Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: K
authors.initials: K
authors.lastname: Pike
authors.affiliation: Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: C A
authors.initials: CA
authors.lastname: Rogers
authors.affiliation: Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: R C M
authors.initials: RC
authors.lastname: Brierley
authors.affiliation: Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: G D
authors.initials: GD
authors.lastname: Angelini
authors.affiliation: Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK.
authors.forename: G J
authors.initials: GJ
authors.lastname: Murphy
authors.affiliation: Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: B C
authors.initials: BC
authors.lastname: Reeves
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood / Q000209:etiology / Q000628:therapy*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003362:Cost-Benefit Analysis; D017707:Erythrocyte Transfusion / Q000191:economics; D004912:Erythrocytes; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D017721:Hospital Costs; D006760:Hospitalization; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000191:economics / Q000628:therapy*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013222:State Medicine; D006113:United Kingdom
chemical_list: D006454:Hemoglobins
keywords: blood transfusion; cost-effectiveness