Efficacy and cost effectiveness of autologous blood predeposit in patients undergoing radical prostatectomy procedures

Abstract

Objectives To assess the efficacy and cost-effectiveness of preoperative autologous blood donation (PAD) in radical prostatectomy procedures. Methods A retrospective 3-year review was performed of transfusion outcomes in radicalprostatectomy procedures. Costs, benefits, and cost-effectiveness were established using a previously published Markov decision analysis model. Results Three hundred eighty-four (97%) of 394 patients predonated 3.5 ± 0.6 (mean±SD) autologous blood units. Of these, 2.1 ± 1.2 units (60%) were retransfused. Forty-two (11 %) of 394 patients also received allogeneic blood. Autologous blood donors received only 0.2 ± 0.6 allogeneic blood units, compared with 1.4 ± 1.4 (p < 0.05) units transfused to patients who did not predonate. The net costs of PAD ranged from $83 to $303 per procedure. The life-expectancy benefit of PAD ranged from 0.05 to 0.07 days. The overall cost-effectiveness of PAD was estimated to be $1,813,000 per quality adjusted life-year saved. However, PAD was significantly more cost-effective for 2 unit donations ($531,000 per quality adjusted life-year saved). Conclusions We conclude that autologous blood donation is an effective blood conservation strategy in elective radical prostatectomy. However, the cost-effectiveness of this practice compares unfavorably with that reported for other medical interventions. Alternative and more cost-effective strategies to reduce the need for allogeneic blood in this setting must be developed.