Cost‐effectiveness of patient blood management methods in elective orthopaedic surgery

Abstract

BackgroundA randomized study was conducted on the integrated use of patient blood management methods as erythropoietin (Epo), cell saver and/or postoperative drain reinfusion to evaluate the effect on red blood cell (RBC) transfusion reduction and costs in 2442 adult elective hip and knee surgery patients while applying a restrictive transfusion threshold.MethodsFirstly, patients were stratified by the preoperative haemoglobin (Hb) level: low Hb (10–13 g/dl) patients were randomized for Epo or no Epo and normal Hb patients (above 13 g/dl) were ineligible for Epo. Secondly, patients from both strata were randomized for autologous reinfusion by cell saver device or postoperative drain reinfusion device or for no blood salvage device. Outcome measures: RBC use and cost‐effectiveness.ResultsEpo resulted in a significant 50% reduction of transfused patients (OR 0·5, 95% CI: 0·35–0·75) and a non‐significant 29% mean reduction in RBC use (ratio 0·71, 0·42–1·13). Epo, however, increased costs by €785 per patient (262–1309), that is €7300 per avoided transfusion (1900–24000). In both strata, autologous blood reinfusion did not result in a RBC reduction and increased costs by €378 per patient (161–595).ConclusionsIn elective knee and hip surgery, while using a restrictive transfusion trigger, autologous reinfusion by cell saver and postoperative drain reinfusion were no longer found to be effective in reducing RBC use and are consequently not cost‐effective, while Epo, although it is effective in reducing RBC use, is not cost‐effective due to its high costs. Therefore, these interventions are no longer considered as appropriate transfusion alternatives.