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.
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.
Authors: S Petrou; M Dooley; L Whitaker; E Beck; E Kupek; J Wadsworth; D Miller; A Renton Journal: Pharmacoeconomics Date: 1996-04 Impact factor: 4.981
Authors: J G Donahue; A Muñoz; P M Ness; D E Brown; D H Yawn; H A McAllister; B A Reitz; K E Nelson Journal: N Engl J Med Date: 1992-08-06 Impact factor: 91.245
Authors: E M Lackritz; G A Satten; J Aberle-Grasse; R Y Dodd; V P Raimondi; R S Janssen; W F Lewis; E P Notari; L R Petersen Journal: N Engl J Med Date: 1995-12-28 Impact factor: 91.245
Authors: Mei Sheng Duh; Jennifer R Weiner; Leigh Ann White; Patrick Lefebvre; Paul E Greenberg Journal: Pharmacoeconomics Date: 2008 Impact factor: 4.981