The cost-effectiveness of preoperative autologous blood donation for total hip and knee replacement

Authors

  • J.D. Birkmeyer,

    Resident, Corresponding author
    1. Program in Medical Information Science, the Technology Assessment Program
    2. Departments of Surgery, Pathology, and Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
    3. Departments of Medicineand Pathology, Washington University Medical Center, St. Louis, Missouri.
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    • 4

      John D. Birkmeyer, MD, Fellow, Program in Medical Information Science;

  • L.T. Goodnough,

    1. Program in Medical Information Science, the Technology Assessment Program
    2. Departments of Surgery, Pathology, and Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
    3. Departments of Medicineand Pathology, Washington University Medical Center, St. Louis, Missouri.
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    • 6

      Lawrence T. Goodnough, MD, Associate Professor, Departments of Medicine and Pathology, Washington University Medical Center, St. Louis, MO.

  • J.P. AuBuchon,

    1. Program in Medical Information Science, the Technology Assessment Program
    2. Departments of Surgery, Pathology, and Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
    3. Departments of Medicineand Pathology, Washington University Medical Center, St. Louis, Missouri.
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    • 7

      James P. AuBuchon, MD, Associate Professor, Department of Pathology, Dartmouth-Hitchcock Medical Center.

  • P.G. Noordsij,

    1. Program in Medical Information Science, the Technology Assessment Program
    2. Departments of Surgery, Pathology, and Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
    3. Departments of Medicineand Pathology, Washington University Medical Center, St. Louis, Missouri.
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    • 8

      Peter G. Noordsij, MD, Resident, Section of Orthopedic Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center.

  • B. Littenberg

    1. Program in Medical Information Science, the Technology Assessment Program
    2. Departments of Surgery, Pathology, and Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
    3. Departments of Medicineand Pathology, Washington University Medical Center, St. Louis, Missouri.
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    • 9

      Benjamin Littenberg, MD, Assistant Professor, Department of Medicine, and Director, Technology Assessment Program, Dartmouth-Hitchcock Medical Center.


5Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756

Abstract

Although the frequency of preoperative autologous blood donation is increasing dramatically, the economic implications of its use remain largely unexplored. Decision analysis was used to calculate the cost- effectiveness of autologous blood donation for hip and knee replacement. Cost-effectiveness, expressed as cost per quality-adjusted year of life saved, was based on observed red cell use in 629 patients undergoing surgery at two tertiary-care centers. Autologous blood donation for bilateral and revision joint replacement cost $40,000 per quality-adjusted year of life saved at Center 1 and $241,000 at Center 2. Autologous blood donation for primary unilateral hip replacement cost $373,000 per quality-adjusted year of life saved at Center 1 and $740,000 at Center 2. Autologous blood donation was least cost- effective for primary unilateral knee replacement ($1,147,000/quality- adjusted year of life saved at Center 1 and $1,467,000/year at Center 2). Differences between autologous blood collections and transfusion requirements explained variations among procedures in the cost- effectiveness of autologous blood donation. Higher transfusion rates in autologous blood donors than in nondonors accounted for the poorer cost- effectiveness of autologous blood donation at Center 2 than at Center 1. Autologous blood donation is not as cost-effective as most accepted medical practices. Its cost-effectiveness can be improved substantially by the avoidance of overcollection and overtransfusion of autologous blood.

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