Abstract
Objective: The objective of this study was to assess the cost effectiveness of using epoetin-α (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 develo** transfusion-related diseases, the costs of transfusion-related diseases and their impact on life expectancy, and the effect of epoetin-α on the probability of transfusion.
Interventions: The efficacy of epoetin-α was derived from data from a meta-analysis of published randomised trials comparing the use of epoetin-α 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-α 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-α to reduce perioperative allogeneic transfusions in cardiac surgery is not cost effective.
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Acknowledgements
Funding for this study was provided by the Canadian Coordinating Office of Health Technology Assessment (CCOHTA). We would like to acknowledge the following for providing reviews of the preliminary draft to CCOHTA: Dr D. Anderson, Dr S. Grover, Dr M. Krahn, Dr G. Paiement, Dr B. O’Brien and Dr N. Otten. We are also grateful to Dr J. Dupuis, S. Grimes and Dr B. Gibis for their assistance in providing data for this report.
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Coyle, D., Lee, K.M., Fergusson, D.A. et al. Cost Effectiveness of Epoetin-α to Augment Preoperative Autologous Blood Donation in Elective Cardiac Surgery. Pharmacoeconomics 18, 161–171 (2000). https://doi.org/10.2165/00019053-200018020-00006
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DOI: https://doi.org/10.2165/00019053-200018020-00006