• Antifibrinolytics;
  • Blood transfusion;
  • Cost-effectiveness analysis;
  • Recombinant human erythropoietin;
  • Preoperative autologous blood donation;
  • Transfusion alternatives


Background and Objectives: Pharmacoeconomics provides a standardized methodology for valid comparisons of interventions in different fields of healthcare. The role of pharmacoeconomics in the safety of blood, blood products and alternatives has however been very limited up to today. This paper discusses the pharmacoeconomic evaluations of alternatives to blood transfusion that have been published in the scientific literature.

Methods: We reviewed pharmacoeconomic methodology with special reference to cost-effectiveness and cost-utility analysis. We searched the literature for such cost-effectiveness analyses related to alternatives to blood transfusion.

Results: Net costs per quality-adjusted life year (QALY) gained varied from cost-saving for reduction of blood transfusions by antifibrinolytics and for analyses which included assumed complications caused by transfusion-related immunomodulation to more than a hundred millions of US$ per QALY gained for preoperative autologous donation by transurethral prostatectomy patients and epoetin augmentation of preoperative autologous donation.

Conclusions: Currently preoperative autologous blood donation with or without epoetin augmentation and epoetin in the absence of autologous transfusion cannot be regarded as cost-effective healthcare interventions for the general population. Perioperative use of antifibrinolytics may be cost-saving, but at present evidence is scarce. Cost-effectiveness of alternatives to blood transfusion may improve if the impact of adverse effects of allogeneic transfusion, such as immunomodulation, bacterial infection and TRALI, can be further substantiated, if the costs of allogeneic blood transfusion continue to rise due to the introduction of (more) safety measures or if donor blood becomes scarce.