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Mortality risks, costs, and decision making in transfusion medicine
1Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Box 608, 601 Elmwood Ave, Rochester, NY 14642, USA.
American Journal of Clinical Pathology
|May 8, 2001
Summary
Analyzing transfusion costs by deaths averted reveals leukocyte-reduced transfusions and HIV-1 antibody testing are highly cost-efficient for saving lives. Apheresis platelets and solvent detergent plasma are less cost-effective for mortality reduction.
Area of Science:
- Health Economics
- Transfusion Medicine
- Public Health
Background:
- Traditional cost-effectiveness analyses like quality-adjusted life year (QALY) can be complex.
- Assigning monetary values to severe outcomes like death is often arbitrary.
- An alternative approach focusing on costs to avert fatal outcomes may aid resource allocation in transfusion medicine.
Purpose of the Study:
- To evaluate the cost-effectiveness of transfusion medicine technologies based on the cost per death averted.
- To compare the cost per death avoided for apheresis platelets, solvent detergent-treated plasma, and leukocyte-reduced transfusions against donor viral testing.
- To inform resource allocation decisions for transfusion services.
Main Methods:
- Calculated the incremental cost per death avoided for specific transfusion interventions and donor viral testing.
- Interventions analyzed included apheresis platelets vs. random platelets, solvent detergent plasma vs. untreated plasma, and leukocyte-reduced vs. unmodified transfusions in cardiac surgery.
- Data were compared with current donor viral testing (HIV-1 antibody and antigen testing).
Main Results:
- Leukocyte-reduced transfusions in cardiac surgery cost $11,000 per death avoided, averting 14 deaths annually.
- HIV-1 antibody testing cost $22,000 per death avoided, averting 6.0 deaths annually.
- Single-donor apheresis platelets ($15 million/death averted) and solvent detergent plasma ($17 million/death averted) were significantly more expensive with fewer deaths averted.
Conclusions:
- HIV-1 antibody testing and leukocyte-reduced transfusions in cardiac surgery represent comparably cost-efficient methods for reducing transfusion-related mortality.
- Solvent detergent plasma and apheresis platelets are less cost-effective strategies for mortality reduction in transfusion medicine.
- Cost-effectiveness analysis focused on averting deaths provides a valuable adjunct to QALY analysis for resource allocation.
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