Cost Effectiveness of Epoetin- to Augment Preoperative Autologous Blood Donation in Elective Cardiac Surgery

Authors: Coyle D.^{1, 2}; Lee K.M.³; Fergusson D.A.¹; Laupacis A.^{1, 2}

Source: PharmacoEconomics, Volume 18, Number 2, August 2000 , pp. 161-171(11)

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Abstract:

Objective: The objective of this study was to assess the cost effectiveness of using epoetin- alpha (erythropoietin) to augment preoperative autologous donation (PAD) of blood prior to elective cardiac surgery.

Design and setting: We designed a decision-analytic model incorporating the risk of receiving allogeneic blood, the costs of blood products, the likelihood of developing transfusion-related diseases, the costs of transfusion-related diseases and their impact on life expectancy, and the effect of epoetin- alpha on the probability of transfusion.

Interventions: The efficacy of epoetin- alpha was derived from data from a meta-analysis of published randomised trials comparing the use of epoetin- alpha to augment PAD with the use of PAD alone. Estimates for the other parameters were obtained by a systematic review of the literature.

Main outcome measures and results: The use of epoetin- alpha reduced the proportion of patients receiving allogeneic transfusions by 60% (from 31.6 to 12.7%). However, this led to only a modest benefit of 0.000035 life years gained per patient and an incremental cost per life year gained of $Can44.6 million (1998 Canadian dollars). A detailed sensitivity analysis confirmed that the cost-effectiveness ratio was larger than that which is generally considered acceptable.

Conclusions: Our study indicates that the use of epoetin- alpha to reduce perioperative allogeneic transfusions in cardiac surgery is not cost effective.

Keywords: Antianaemics, therapeutic use; Blood transfusion; Cost effectiveness; Epoetin alfa, therapeutic use; Heart surgery; Pharmacoeconomics

Language: English

Document Type: Original article

Affiliations: 1: Clinical Epidemiology Unit, Loeb Health Research Institute, Ottawa Hospital, Ottawa, Canada 2: Departments of Medicine and Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada 3: Health Priorities Research Group, University of California - Irvine, Irvine, California, USA *

Publication date: 2000-08-01

Cost Effectiveness of Epoetin- to Augment Preoperative Autologous Blood Donation in Elective Cardiac Surgery

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