Cost-effectiveness of a post-splenectomy registry for prevention of sepsis in the asplenic

Background: Overwhelming, sometimes fatal infections represent a lifelong risk after surgical removal of the spleen, or in patients who develop hyposplenism as a consequence of illnesses. This risk may be reduced by all or a combination of vaccination, antibiotic prophylaxis and education. We aimed to determine if a registry approach to delivering these interventions would be cost effective using our own experience and published data. Method: The decision model compared a cohort of 1,000 people covered by a registry to a cohort of 1,000 people with no registry. The impact of the registry was assessed in terms of achieved rates of vaccination, chemoprophylaxis and education, consequent outcomes of overwhelming post-splenectomy infection (OPSI) and mortality (years of life lived). The cost-effectiveness of the registry compared with no registry was estimated in terms of additional cost per case of OPSI avoided and as additional cost per life year gained. Results: In the first two years, the additional cost of the registry was $152,611 per case of OPSI avoided or $205,931 per life year gained. After this initial registration period the cost-effectiveness improves over time, such that over the cohort lifetime a post-splenectomy register is associated with an additional cost of $105,159 per case of OPSI avoided or $16,113 per life year gained. Conclusion: A registry-based approach is likely to prove cost effective in terms of mortality and rates of OPSI avoided.