Economic evaluation of a randomized clinical trial of haemodilution with cell salvage in aortic surgery

Authors: Haynes S.L.¹; Torella F.¹; Wong J.C.L.¹; Dalrymple K.¹; James M.²; McCollum C.N.¹

Source: British Journal of Surgery, Volume 89, Number 6, June 2002 , pp. 731-736(6)

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Abstract:

Background:

This study evaluated the costs of acute normovolaemic haemodilution (ANH) and intraoperative cell salvage (ICS) versus homologous blood transfusion in aortic surgery in a prospective multicentre randomized trial. Methods:

One hundred and forty-five patients were randomized either to standard transfusion practice (homologous) or to a combination of ANH and ICS (autologous). Costs for each inpatient admission were identified. Cell salvage costs were assigned on the assumption that 50 operations were done each year employing a trained cell salvage operator. The results were analysed statistically using bias-corrected bootstrap analysis. Results:

Patients who had transfusion of homologous blood received some 251 units and those having a homologous transfusion received 103 units (P = 0·008). There was no difference in morbidity, mortality and duration of hospital stay. Transfusion-related mean costs were similar at £340 for patients having a homologous transfusion and £357 for those receiving autologous blood (mean difference £17 (95 per cent confidence interval (c.i.) – £184 to £174); P not significant). There was also no significant difference in mean overall costs: £5859 for homologous and £5384 for autologous transfusion (mean difference – £475 (95 per cent c.i. – £2231 to £1342)). Sensitivity analysis showed that costs remained similar for 20 and 150 operations per annum. Exclusion of a dedicated cell salvage operator reduced autologous transfusion costs but did not have a significant impact on overall cost. Conclusion:

Autologous transfusion is cost neutral in aortic surgery even when surgical activity is low.

Document Type: Research article

DOI: http://dx.doi.org/10.1046/j.1365-2168.2002.02086.x

Affiliations: 1: Academic Surgery Unit, South Manchester University Hospital, Wythenshawe, Manchester and 2: Department of Health Planning and Management, University of Keele, Keele, UK

Publication date: 2002-06-01

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Economic evaluation of a randomized clinical trial of haemodilution with cell salvage in aortic surgery

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