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Erythropoietin and preoperative autologous blood donation in the prevention of hepatitis C infection: necessity or luxury? |
Woronoff-Lemsi M C, Arveux P, Limat S, Morel P, Le Pen C, Cahn J Y |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The use of recombinant human erythropoietin (rHuEPO) in pre-operative blood donation (PBD) in orthopaedic surgery.
Economic study type Cost-effectiveness analysis.
Study population A hypothetical cohort of 100,000 patients entering a PBD programme.
Setting Hospital. The study was carried out at the Besancon University Hospital, Besancon, France.
Dates to which data relate Effectiveness data were derived from studies published between 1994 and 1996. Cost data were collected from 1996-1997 sources. The price year was 1997.
Source of effectiveness data Effectiveness data were derived from a literature review.
Modelling A decision analytic model was used to determine the cost-effectiveness of the two strategies to prevent hepatitis C infection.
Outcomes assessed in the review The review assessed the following outcomes: the probability of transfusing allogeneic red blood cells (RBCs), the residual risk of hepatitis C virus (HCV) infection, and the number of RBCs.
Study designs and other criteria for inclusion in the review Sources searched to identify primary studies Criteria used to ensure the validity of primary studies Methods used to judge relevance and validity, and for extracting data Summary statistics from individual studies.
Number of primary studies included At least 2 studies were included in the review.
Methods of combining primary studies Investigation of differences between primary studies Results of the review The probability of transfusing allogeneic RBCs varied between 0.03 and 0.9. The residual risk of HCV infection was 1 in 100,000 patients. It was assumed that each patient received 3 RBC units during an operation.
Measure of benefits used in the economic analysis The number of Hepatitis C infections prevented was used as the measure of benefits.
Direct costs Direct costs were not discounted given the short time frame of the study (less than 1 year). Quantities and costs were reported separately. Direct costs included the cost of allogeneic transfusion (white cell reduction and phenotyping costs), the cost of the PBD programme, and the cost of rHuEPO. The quantity/cost boundary adopted was that of the health service. The estimation of quantities and costs was based on actual data. The RBC unit price was based on the official French tariff for blood components. Unit prices for rHuEPO were obtained from wholesale price lists for the Besancon University Hospital Pharmacy in 1997. The price year was 1997.
Statistical analysis of costs Currency US dollars ($), with Ffr6 = US$1.
Sensitivity analysis Sensitivity analyses were performed on the probability of transfusing allogeneic RBCs, the residual risk of HCV infection, the number of RBCs, the administration schedules of rHuEPO, and the cost of rHuEPO.
Estimated benefits used in the economic analysis The number of HCV infections prevented per 100,000 people by the use of rHuEPO was 0.30562.
Cost results The added cost of the rHuEPO adjunct to PBD amounted to $2,712 per patient.
Synthesis of costs and benefits The incremental cost of preventing one HCV infection amounted to $880,000,000. These results did not change in the sensitivity analysis.
Authors' conclusions The cost-effectiveness ratio was so large that variations only slightly modified the size of the result. From the societal perspective, it was not cost-effective to add rHuEPO to pre-operative blood donation.
CRD COMMENTARY - Selection of comparators The rationale for the choice of the comparator was clear. You, as a user of this database, should verify whether these health technologies are relevant to your setting.
Validity of estimate of measure of benefit A relevant measure of benefit was used. The evaluation of efficiency was based solely on HCV residual risk. By retaining only this risk, the authors did not take into account the other viral and bacterial infectious risks nor that of alloimmunisation. The model neglected the use of autotransfusion during the operation (normovolemic hemodilution and operation blood recuperation). The authors did not consider quality of life measures which would be relevant for those infected. The effectiveness data have been derived from, what may have been, a non-systematic review of the literature and therefore the internal validity of effectiveness estimates cannot be fully assessed given the limited information provided about the review and the quality assessment of the primary studies. Efficiency measures were derived from only two studies. The authors, however, acknowledged the lack of available data.
Validity of estimate of costs Only direct costs were considered. Indirect costs such as those related to productivity lost or gained were not included but would be relevant for infected individuals. Some cost estimates were based on tariffs and, hence, do not represent true opportunity costs. Some cost estimates were collected from the local hospital pharmacy and are unlikely to be generalisable to other settings.
Other issues Adequate comparisons with other relevant studies were not made and the generalisability of the results to other settings or countries was not discussed. The authors do not appear to have presented their results selectively. The study examined patients entering a PBD programme and this was reflected in the authors' conclusions.
Implications of the study More research is needed on the efficiency of adding rHuEPO to a PBD programme.
Bibliographic details Woronoff-Lemsi M C, Arveux P, Limat S, Morel P, Le Pen C, Cahn J Y. Erythropoietin and preoperative autologous blood donation in the prevention of hepatitis C infection: necessity or luxury? Transfusion 1999; 39(9): 933-937 Indexing Status Subject indexing assigned by NLM MeSH Blood Donors; Blood Transfusion, Autologous /economics; Combined Modality Therapy /economics; Cost-Benefit Analysis; Erythropoietin /therapeutic use; Hepatitis C /prevention & Humans; Preoperative Care; Recombinant Proteins; Sensitivity and Specificity; control AccessionNumber 21999001747 Date bibliographic record published 31/08/2000 Date abstract record published 31/08/2000 |
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