Elsevier

Urology

Volume 44, Issue 2, August 1994, Pages 226-231
Urology

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

https://doi.org/10.1016/S0090-4295(94)80136-3Get rights and content

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.

References (45)

  • Standards Committee

    Standards for Blood Banks and Transfusion Services

  • HuffR.L. et al.

    Relationship of circulating red cell volume to body density and obesity

    J Clin Invest

    (1956)
  • GoodnoughL.T. et al.

    Identifying elective orthopedic surgical patients trasfused with amounts of blood in excess of need: the transfusion trigger revisited

    Transfusion

    (1992)
  • GoodnoughL.T. et al.

    Red blood cell mass in autologous and homologous blood units. Implications for risk/benefit assessment for autologous blood crossover and directed blood transfusion

    Transfusion

    (1989)
  • WeinsteinM.C. et al.

    Clinical Decision Analysis

    (1980)
  • BeckJ.R. et al.

    The Markov process in medical prognosis

    Med Decis Making

    (1983)
  • FinklerS.A.

    The distinction between costs and charges

    Ann Intern Med

    (1982)
  • ForbesJ.M. et al.

    Blood transfusion costs: a multicenter study

    Transfusion

    (1991)
  • DoddR.Y.

    The risk of transfusion-transmitted infection

    N Engl J Med

    (1992)

  • Public Health Service Interagency guidelines for screening donors of blood, plasma, organs, tissues, and semen for evidence of hepatitis B and hepatitis C

    MMWR

    (1991)
  • DonahueJ.G. et al.

    The declinining risk of post-transfusion hepatitis C virus infection

    N Engl Med

    (1992)
  • SeeffL.B. et al.

    Long-term mortality after transfusion associated non-A, non-B hepatitis

    N Engl J Med

    (1992)

    • Cited by (0)

    *

    This investigation was supported in part by Transfusion Medicine Academic Award K07 (111-0-1625) from the National Heart, Lung, and Blood Institute of The National Institutes of Health, Bethesda, Maryland.

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