Authors' objectives:

The cost-effectiveness of two strategies were evaluated:

1. The use of erythropoietin (EPO) to augment pre-donation of autologous (patient's) blood (PAD) for both orthopaedic (hip arthroplasty) and cardiac (CABG and valvular replacement) elective surgeries.

2. The use of EPO alone in orthopaedic patients.

Authors' recommendations: 1. The use of EPO reduced the proportion of patients receiving allogeneic transfusion: (a) no predonation (EPO alone): by 51% (from 48% to 24%) in orthopaedic surgery, (b) EPO to augment PAD: by 37% (from 17% to 11%) in orthopaedic and by 60% (from 32% to 13%) in cardiac surgery. 2. The potential life years gained/individual, based on a reduction in the proportion of patients receiving allogeneic transfusion and life-time risks from each allogeneic unit of blood received were: (a) no predonation (EPO alone): 0.000029 life years in orthopaedic surgery (b) EPO to augment PAD: 0.000007 life years in orthopaedic and 0.000043 life years in cardiac surgery. 3. The incremental cost per life year gained was: (a) no predonation (EPO alone): 55 million in orthopaedic surgery (b) EPO to augment PAD: 296 million USD for orthopaedic and 35 million USD for cardiac surgery. The incremental cost per life year gained was even higher when current surgical practices were evaluated. This was primarily due to a decreased baseline need for allogeneic blood. 4. Only under the most extreme case scenario (the highest reported costs of blood products and illnesses related to transfusions, the highest reported risks of transfusion related illnesses, and extreme quality of life effects) did erythropoietin therapy result in a cost per life year gained less than 100,000 USD (90,000 USD for EPO to augment PAD in cardiac surgery). No other scenarios that were tested resulted in the cost per life year gained to be less than 100,000 USD. Other scenarios ranged from assuming all patients without EPO received allogeneic transfusions to increasing the cost of HIV and Hepatitis B and C to 1 million USD each. Compensation to patients contracting blood borne diseases would have to be in excess of 800 million USD/person to reduce the cost per life year gained to less than 100,000 USD. 5. The high incremental cost per life year gained is primarily due to low probabilities of transfusion and the current low risk of contracting known infectious diseases from blood (AIDS: 2 cases/1,000,000 units transfused; Hepatitis C: 10 cases/1,000,000 units transfused; and Hepatitis B: 16 cases/1,000,000 units transfused.) 6. The impact of adopting EPO for 10% of all cases for hip arthroplasties and coronary artery bypass surgeries in Canada would be 5.9 million USD annually. This would result in a potential benefit of 0.12 life years gained for the total population.

Authors' methods: Economic evaluation

Project Status: Completed

URL for project: https://www.ccohta.ca/

Year Published: 1998

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Coordinating Office for Health Technology Assessment

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553, Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: Canadian Coordinating Office for Health Technology Assessment, 1998