RAND Corporation From the SelectedWorks of Emmett Keeler March , 1995 The Cost Effectiveness of Preoperative Autologous Blood Donations
RAND Corporation From the SelectedWorks of Emmett Keeler March , 1995 The Cost Effectiveness of Preoperative Autologous Blood Donations
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2016
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通讯作者：
J. Etchason;L. Petz;E. Keeler;L. Calhoun;S. Kleinman
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作者：
J. Etchason;L. Petz;E. Keeler;L. Calhoun;S. Kleinman
背景资料。自从认识到人类免疫缺陷病毒可以通过输血传播以来，公众和专业人士越来越多地支持在择期手术前自体献血。然而，自体献血是一个比社区志愿者捐献异体血液更昂贵的过程。此外，志愿人员血液供应的安全性最近也有所改善。方法：研究方法。我们使用决策分析模型来评估为四种外科手术捐献自体血液的成本效益。成本数据是从1992年加州大学洛杉矶分校对输血实践的观察中收集的。对输血相关疾病的风险和治疗费用的估计来自医学文献。成本效益以每一质量调整后的寿命年节省的美元表示。我们对模型中的变量进行了敏感性分析，并检查了所建议的降低成本的策略的效果。结果。用自体血液替代异体血液几乎不会带来预期的健康益处(经质量调整的寿命年节省了0.0002至0.00044)，但增加了相当大的成本(每单位血液68至4,783美元)。自体血液的额外成本主要是由于已捐献但未输血的单位被丢弃，以及更劳动密集型的献血过程。每节省一个质量调整的寿命年，成本效益价值从23.5万美元到2300万美元以上不等。结论。鉴于同种异体输血安全性的提高，捐献自体血液所提供的更多保护是有限的，可能无法证明增加的成本是合理的。(N Engl J Med 1995；332：719-24)来自普通内科、西洛杉矶退伍军人事务医学中心和加州大学洛杉矶分校医学院(J.E.)；病理和实验室医学系(L.P.，L.C.，S.K.)医学和卫生服务部(A.F.，R.B.)，加州大学洛杉矶分校健康科学中心(UCLA Center For Health Science)--都在洛杉矶；兰德，加州圣莫尼卡。(J.E.，E.K.，C.S.，R.B.)将转载请求发送给西洛杉矶退伍军人事务医疗中心普通内科，11301 Wilshire Blvd，洛杉矶，CA 90073。部分资金来自罗伯特·伍德·约翰逊临床学者计划(授予埃特查森博士)和国家心脏、肺和血液研究所的输血医学学术奖(K07 HL02151，授予Petz博士和Calhoun女士)。获得性免疫缺陷综合征(AIDS)的流行使人们更加担心通过输血传播传染病的风险。作为对这一担忧的回应，在过去的十年里，术前自体献血的数量急剧增加。1-4尽管关于输血危险的耸人听闻的报道仍在媒体上继续，5但血液供应的安全性已有很大改善，这主要是因为严格的献血者筛查和对人类免疫缺陷病毒(艾滋病毒)和丙型肝炎病毒的敏感血清学测试。6自体血比异体血更昂贵。它的捐赠需要更大的行政费用，以及更长、更劳动密集型的募捐过程。此外，自体器官7、8的传染病检测呈阳性的频率引发了将未使用的自体器官输注给捐赠者以外的患者的安全性的问题。出于这一担忧，85%的美国血液中心不会为其他患者保留未使用的自体血液，而是将其销毁。这种做法大大提高了自体输血的成本。当前关于医疗改革的全国性辩论使得现在是分析自体献血的成本效益的合适时机。在我们的研究中，我们确定了为患者提供自体血液的成本，并使用决策分析技术计算了用自体血液替代异体血液的成本效益。我们还分析了将自体捐献计划的成本降至最低的各种策略的价值。
Background. Since the recognition that human immunodeficiency virus is transmissible by blood transfusion there has been increasing public and professional support for autologous blood donations before elective surgery. Autologous blood donation is, however, a more expensive process than the donation of allogeneic blood by community volunteers. Furthermore, there have been recent improvements in the safety of the volunteer blood supply. Methods. We used a decision-analysis model to assess the cost effectiveness of donating autologous blood for four surgical procedures. Cost data were collected from the observation of transfusion practice at the University of California, Los Angeles, in 1992. Estimates of the risks of transfusion-associated diseases and the costs of treating them came from the medical literature. Cost effectiveness was expressed in dollars per quality-adjusted year of life saved. We performed sensitivity analyses of the variables in our model and examined the effect of strategies suggested to reduce costs. Results. Substituting autologous for allogeneic blood resulted in little expected health benefit (0.0002 to 0.00044 quality-adjusted year of life saved) at considerable additional cost ($68 to $4,783 per unit of blood). The additional cost of autologous blood was primarily a function of the discarding of units that were donated but not transfused and of a more labor-intensive donation process. The cost-effectiveness values ranged from $235,000 to over $23 million per quality-adjusted year of life saved. Conclusions. Given the improved safety of allogeneic transfusions today, the increased protection afforded by donating autologous blood is limited and may not justify the increased cost. (N Engl J Med 1995;332:719-24.) From the Division of General Internal Medicine, West Los Angeles Veterans Affairs Medical Center and the UCLA School of Medicine (J.E.); the Department of Pathology and Laboratory Medicine (L.P., L.C., S.K.) and the Departments of Medicine and Health Services (A.F., R.B.), UCLA Center for Health Sciences — all in Los Angeles; and RAND, Santa Monica, Calif. (J.E., E.K., C.S., R.B.). Address reprint requests to Dr. Etchason at the Division of General Internal Medicine, West Los Angeles Veterans Affairs Medical Center, 11301 Wilshire Blvd., Los Angeles, CA 90073. Supported in part by a grant from the Robert Wood Johnson Clinical Scholars Program (to Dr. Etchason) and by a Transfusion Medicine Academic Award (K07 HL02151, to Dr. Petz and Ms. Calhoun) from the National Heart, Lung, and Blood Institute. T HE epidemic of the acquired immunodeficiency syndrome (AIDS) has increased concern about the risk of transmitting infectious diseases through blood transfusion. In response to this concern, there has been a dramatic increase in preoperative autologous blood donations over the past decade. 1-4 Although sensationalized reports of the dangers of blood transfusion continue in the lay press, 5 there have been great improvements in the safety of the blood supply, primarily because of rigorous donor screening and sensitive serologic tests for the human immunodeficiency virus (HIV) and for hepatitis C virus. 6 Autologous blood is more costly than allogeneic blood. Its donation entails greater administrative expense and a longer, more labor-intensive process of collection. Moreover, the frequency of positive tests for infectious disease in autologous units 7,8 has raised questions about the safety of transfusing unused autologous units into patients other than the donor. Because of this concern, 85 percent of U.S. blood centers do not retain unused autologous units for other patients, but rather destroy them. 9 This practice has substantially raised the cost of autologous transfusion. The current national debate on health care reform makes this an appropriate time to analyze the cost effectiveness of autologous blood donation. In our study, we determined the costs of providing patients with autologous blood and used decision-analysis techniques to calculate the cost effectiveness of substituting autologous for allogeneic blood. We also analyzed the value of various strategies to minimize the costs of autologous-donation programs.