Interventions:
The selection of the comparators, liberal versus restrictive transfusion strategies, was appropriate given their relevance in the authors’ setting.
Effectiveness/benefits:
The sources of data appear to have been selected. The authors provided some information on the design of these sources. They discussed and justified the selection of the clinical evidence from the available data, and their justification appears to have been appropriate. They pointed out some limitations to the studies used to derive some clinical inputs. In particular, it was noted that the linear relationship between pRBC transfusion amounts and the adverse outcomes had not been confirmed in prospective studies. Furthermore, the data on complications associated with liberal transfusion were derived from a single study, which may not reflect treatment patterns in other settings nor real-world practice in general. Finally, the use of two trials to obtain data on the risk of TSACs for the liberal and restrictive strategies could have introduced some bias due to potential differences in patient population between the two studies. Extensive sensitivity analyses were conducted on these parameters to address these issues.
Costs:
The analysis of costs was restricted to the hospital’s viewpoint, which appeared to include only the cost of transfusion products. The unit costs and resource quantities were reported. The cost associated with TSACs was not included due to the limited published evidence. The price year was given. In general, the economic analysis was carried out in a transparent fashion, enhancing the possibility of replicating the analysis for other settings and time periods. The use of discounting was not relevant given the one-year horizon of the model.
Analysis and results:
: A synthesis of costs and benefits was not required given the dominance of one strategy over the other. The costs and benefits were appropriately reported. The issue of uncertainty was satisfactorily addressed in the sensitivity analysis, the results of which were clearly presented. The authors noted that the robust sources of data used in the analysis strengthened the validity of the study findings. Furthermore, when assumptions were required, a conservative approach was adopted. Finally, it was noted that the transparent framework of the model should ensure the applicability of the results to concrete clinical settings. The authors acknowledged, as potential limitations to their analysis, the paucity of the published studies and the fact that TSAC costs were not included.
Concluding remarks:
On the whole, the study was transparently carried out using clear methodology. The authors’ conclusions appear to be valid and enhanced by the extensive sensitivity analysis.
