Cost-effectiveness of leucocyte-depleted erythrocyte transfusion in cardiac valve surgery

被引:11
|
作者
van Hulst, M
Bilgin, YM
van de Watering, LMG
de Vries, R
van Oers, MHJ
Postma, MJ
机构
[1] Univ Groningen, Inst Drug Explorat, GRIP, Dept Social Pharm Pharmacoepidemiol & Pharmacothe, NL-9713 BZ Groningen, Netherlands
[2] Martini Hosp, Dept Clin Pharm & Toxicol, Groningen, Netherlands
[3] Univ Amsterdam, Acad Med Ctr, Dept Haematol, NL-1105 AZ Amsterdam, Netherlands
[4] Leiden Univ, Med Ctr, Dept Immunohaematol & Blood Transfus, Leiden, Netherlands
[5] Sanquin Blood Bank Reg SW, Leiden, Netherlands
关键词
blood transfusion; cost-effectiveness analysis; grafting; surgery; valves;
D O I
10.1111/j.1365-3148.2005.00573.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Cost-effectiveness of leucodepleted erythrocytes (LD) over buffy-coat-depleted packed cells (PC) is estimated from the primary dataset of a recently reported randomized clinical trial involving valve surgery (+/-CABG) patients. Data on the patient level of 474 adult patients who were randomized double-blind to LD or PC were used in order to calculate the healthcare costs and longevity per patient. The incremental cost-effectiveness ratio (ICER) in net costs per life-year gained was established from the healthcare perspective. Bootstrapping and cost-effectiveness acceptability curves were used in order to determine the confidence interval (CI) of the ICER. The longevity of patients in the PC and LD group was 10.6 and 11.4 years, respectively. Relative to PC, LD yielded an estimated 0.8 (95% CI = -0.27 to 1.84) life-year in the baseline. Adjusted for age and sex differences, health gains for LD are 0.4 life-year gained (95% CI = -0.67 to 1.44). Healthcare costs per patient averaged US$ 10163 per patient in the PC group and US$ 9949 in the LD group. Average cost-savings were US$ 214 (95% Cl = -1536 to 1964) per patient. Acceptability curves constructed from bootstrap simulations showed a probability of being cost-saving of 59% for universal leucodepletion from the healthcare perspective. The probability of adopting leucodepletion regardless of the costs reaches 92.7%. LD in patients receiving four or more transfusions showed the highest cost-savings and health gains. Leucodepletion of erythrocytes is a cost-saving strategy in cardiac valve (+/-CABG) patients. However, probablistic analysis failed to show a significant difference with buffy-coat-depleted PC.
引用
收藏
页码:209 / 217
页数:9
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