THE COST-EFFECTIVENESS OF PREOPERATIVE AUTOLOGOUS BLOOD DONATIONS
THE COST-EFFECTIVENESS OF PREOPERATIVE AUTOLOGOUS BLOOD DONATIONS
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DOI：
10.1056/nejm199503163321106
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发表时间：
1995-03-16
影响因子：
158.5
通讯作者：
BROOK, R
中科院分区：
文献类型：
--
作者：
ETCHASON, J;PETZ, L;BROOK, R
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，自体献血是一种比社区志愿者捐献异体血液更昂贵的过程，而且，最近在志愿者血液供应的安全性方面有了改进。我们使用决策分析模型来评估四种外科手术中捐献自体血液的成本效益，成本数据收集自1992年对加州大学洛杉矶分校输血实践的观察，对输血相关疾病风险和治疗成本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，并检验了建议的降低成本的策略的效果。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，每节省一年的质量调整后的成本效益价值从23.5万美元到2300多万美元。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。
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.