Medical School, University of Western Australia, Perth, Western Australia, Australia.
Department of Anaesthesia and Pain Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
Anaesthesia. 2021 Mar;76(3):357-365. doi: 10.1111/anae.15240. Epub 2020 Aug 27.
Our study investigated whether pre-operative screening and treatment for anaemia and suboptimal iron stores in a patient blood management clinic is cost effective. We used outcome data from a retrospective cohort study comparing colorectal surgery patients admitted pre- and post-implementation of a pre-operative screening programme. We applied propensity score weighting techniques with multivariable regression models to adjust for differences in baseline characteristics between groups. Episode-level hospitalisation costs were sourced from the health service clinical costing data system; the economic evaluation was conducted from a Western Australia Health System perspective. The primary outcome measure was the incremental cost per unit of red cell transfusion avoided. We compared 441 patients screened in the pre-operative anaemia programme with 239 patients not screened; of the patients screened, 180 (40.8%) received intravenous iron for anaemia and suboptimal iron stores. The estimated mean cost of screening and treating pre-operative anaemia was AU$332 (£183; US$231; €204) per screened patient. In the propensity score weighted analysis, screened patients were transfused 52% less red cell units when compared with those not screened (rate ratio = 0.48, 95%CI 0.36-0.63, p < 0.001). The mean difference in total screening, treatment and hospitalisation cost between groups was AU$3776 lower in the group screened (£2080; US$2629; €2325) (95%CI AU$1604-5947, p < 0.001). Screening elective patients pre-operatively for anaemia and suboptimal iron stores reduced the number of red cell units transfused. It also resulted in lower total costs than not screening patients, thus demonstrating cost effectiveness.
我们的研究旨在探讨在患者血液管理诊所中，术前筛查和治疗贫血及铁储备不足是否具有成本效益。我们使用了一项回顾性队列研究的结果数据，该研究比较了在实施术前筛查计划前后接受结直肠手术的患者。我们应用倾向评分加权技术和多变量回归模型来调整组间基线特征的差异。住院费用来源于卫生服务临床成本数据系统；经济评价从西澳大利亚卫生系统的角度进行。主要结果测量指标为避免每单位红细胞输注的增量成本。我们比较了在术前贫血计划中筛查的 441 名患者与未筛查的 239 名患者；在筛查的患者中，180 名（40.8%）因贫血和铁储备不足接受了静脉铁治疗。筛查和治疗术前贫血的估计平均成本为每位筛查患者 332 澳元（183 英镑；231 美元；204 欧元）。在倾向评分加权分析中，与未筛查的患者相比，筛查的患者输注红细胞单位数减少了 52%（率比=0.48，95%CI 0.36-0.63，p<0.001）。两组间总筛查、治疗和住院费用的平均差异为筛查组低 3776 澳元（2080 英镑；2629 美元；2325 欧元）（95%CI 澳元 1604-5947，p<0.001）。术前筛查择期手术患者的贫血和铁储备不足可减少红细胞单位的输注量。它还导致总成本低于不筛查患者，因此具有成本效益。
