The cost‐effectiveness of autologous transfusion alternatives: an update and reappraisal

Abstract

SUMMARYThere is still an ongoing debate whether autologous transfusion methods (ATM) are cost‐effective when compared with each other or with other medical interventions. A search on MEDLINE and in the British National Health Service Economic Evaluation Database was conducted to retrieve cost‐effectiveness analyses focusing on preoperative autologous blood donation (PABD), acute normovolemic hemodilution (ANH) or perioperative blood salvage (PBS). The search covered the years from 1991 to 2006. The quality of retrieved papers was assessed using published criteria for the evaluation of economic analyses of health‐care measures. Twenty‐six studies were identified: ten for PABD, four for ANH, seven for PBS and five which evaluated strategies combining different ATM. Nineteen studies were conducted in the USA, including most of the PABD studies. Only one study included indirect costs in its cost estimates. The majority of analyses were based on suboptimal study designs. Only six studies employed randomized controlled trials, in most of which avoidance of allogeneic transfusion was chosen as the effectiveness parameter. Ten studies used decision analysis models, calculating cost‐effectiveness ratios based on quality‐adjusted life‐years. These included eight PABD studies and two PBS studies. The assumptions needed for the models were often either outdated or derived from unsystematic reviews of the pertinent literature. In conclusion, economic analyses of ATM are heterogeneous with respect to several aspects of study design. The currently available scientific evidence is of limited quality because of considerable uncertainties in estimates of several key variables thought to substantially affect the results of economic analyses.