Coyle D, Lee K M, Fergusson D A, Laupacis A
Clinical Epidemiology Unit, Loeb Health Research Institute, Ottawa Hospital, Canada.
Pharmacoeconomics. 2000 Aug;18(2):161-71. doi: 10.2165/00019053-200018020-00006.
The objective of this study was to assess the cost effectiveness of using epoetin-alpha (erythropoietin) to augment preoperative autologous donation (PAD) of blood prior to elective cardiac surgery.
We designed a decision-analytic model incorporating the risk of receiving allogeneic blood, the costs of blood products, the likelihood of developing transfusion-related diseases, the costs of transfusion-related diseases and their impact on life expectancy, and the effect of epoetin-alpha on the probability of transfusion.
The efficacy of epoetin-alpha was derived from data from a meta-analysis of published randomised trials comparing the use of epoetin-alpha to augment PAD with the use of PAD alone. Estimates for the other parameters were obtained by a systematic review of the literature.
The use of epoetin-alpha reduced the proportion of patients receiving allogeneic transfusions by 60% (from 31.6 to 12.7%). However, this led to only a modest benefit of 0.000035 life years gained per patient and an incremental cost per life year gained of $Can44.6 million (1998 Canadian dollars). A detailed sensitivity analysis confirmed that the cost-effectiveness ratio was larger than that which is generally considered acceptable.
Our study indicates that the use of epoetin-alpha to reduce perioperative allogeneic transfusions in cardiac surgery is not cost effective.
本研究的目的是评估使用促红细胞生成素α（红细胞生成素）增加择期心脏手术前术前自体血捐献（PAD）的成本效益。
我们设计了一个决策分析模型，纳入了接受异体血的风险、血液制品的成本、发生输血相关疾病的可能性、输血相关疾病的成本及其对预期寿命的影响，以及促红细胞生成素α对输血概率的影响。
促红细胞生成素α的疗效源自已发表的随机试验的荟萃分析数据，这些试验比较了使用促红细胞生成素α增加PAD与单独使用PAD的情况。其他参数的估计值通过对文献的系统综述获得。
使用促红细胞生成素α使接受异体输血的患者比例降低了60%（从31.6%降至12.7%）。然而，这仅为每位患者带来了适度的益处，即增加了0.000035个生命年，每增加一个生命年的增量成本为4460万加元（1998年加拿大元）。详细的敏感性分析证实，成本效益比高于通常认为可接受的水平。
我们的研究表明，在心脏手术中使用促红细胞生成素α减少围手术期异体输血不具有成本效益。
