Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY, 12208, USA.
Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT, 06106, USA.
Int Urogynecol J. 2024 Apr;35(4):781-791. doi: 10.1007/s00192-023-05696-x. Epub 2024 Jan 19.
Routine preoperative type and screen (T&S) is often ordered prior to urogynecological surgery but is rarely used. We aimed to assess the cost effectiveness of routine preoperative T&S and determine transfusion and transfusion reaction rates that make universal preoperative T&S cost effective.
A decision tree model from the health care sector perspective compared costs (2020 US dollars) and effectiveness (quality-adjusted life-years, QALYs) of universal preoperative T&S (cross-matched blood) vs no T&S (O negative blood). Our primary outcome was the incremental cost-effectiveness ratio (ICER). Input parameters included transfusion rates, transfusion reaction incidence, transfusion reaction severity rates, and costs of management. The base case included a transfusion probability of 1.26%; a transfusion reaction probability of 0.0013% with or 0.4% without T&S; and with a transfusion reaction, a 50% probability of inpatient management and 0.0042 annual disutility. Costs were estimated from Medicare national reimbursement schedules. The time horizon was surgery/admission. We assumed a willingness-to-pay threshold of $150,000/QALY. One- and two-way sensitivity analyses were performed.
The base case and one-way sensitivity analyses demonstrated that routine preoperative T&S is not cost effective, with an ICER of $63,721,632/QALY. The optimal strategy did not change when base case cost, transfusion probability, or transfusion reaction disutility were varied. Threshold analysis revealed that if transfusion reaction probability without T&S is >12%, routine T&S becomes cost effective. Scenarios identified as cost effective in the threshold and sensitivity analyses fell outside reported rates for urogynecological surgery.
Within broad ranges, preoperative T&S is not cost effective, which supports re-evaluating routine T&S prior to urogynecological surgery.
术前常规血型和交叉配血（T&S）常用于妇科泌尿科手术，但很少使用。我们旨在评估常规术前 T&S 的成本效益，并确定使通用术前 T&S 具有成本效益的输血和输血反应率。
从医疗保健部门的角度来看，决策树模型比较了通用术前 T&S（交叉配血）与无 T&S（O 型阴性血）的成本（2020 年美元）和效果（质量调整生命年，QALYs）。我们的主要结果是增量成本效益比（ICER）。输入参数包括输血率、输血反应发生率、输血反应严重程度率以及管理成本。基础案例包括输血概率为 1.26%；有无 T&S，输血反应概率分别为 0.0013%和 0.4%；输血反应后，50%的患者需要住院治疗，每年有 0.0042 的失能。成本根据 Medicare 国家报销计划进行估算。时间范围为手术/住院。我们假设愿意支付的阈值为 150,000 美元/QALY。进行了单因素和双因素敏感性分析。
基础案例和单因素敏感性分析表明，常规术前 T&S 不具有成本效益，ICER 为 63,721,632 美元/QALY。当改变基础案例成本、输血概率或输血反应失能时，最佳策略没有改变。阈值分析表明，如果没有 T&S 的输血反应概率>12%，则常规 T&S 具有成本效益。在阈值和敏感性分析中确定为具有成本效益的方案落在报告的妇科泌尿科手术率之外。
在广泛的范围内，术前 T&S 不具有成本效益，这支持重新评估妇科泌尿科手术前的常规 T&S。
