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Cost-effectiveness of leucocyte-depleted erythrocyte transfusion in cardiac valve surgery
M van Hulst1, Y M Bilgin, L M G van de Watering
1Department of Social Pharmacy, Pharmaco-epidemiology and Pharmacotherapy Groningen University Institute for Drug Exploration/Groningen Research Institute of Pharmacy (GUIDE/GRIP), the Netherlands. m.van.hulst@rug.nl
Insights
Leucodepleted erythrocytes (LD) may offer cost savings and improved longevity compared to buffy-coat-depleted packed cells (PC) in cardiac surgery patients. Probabilistic analysis did not reveal a statistically significant difference, but LD showed potential as a cost-saving strategy.
Area of Science:
- Transfusion Medicine
- Health Economics
- Cardiovascular Surgery
Background:
- Red blood cell transfusions are common in cardiac surgery.
- Leukodepletion aims to reduce transfusion-related complications.
- Cost-effectiveness of leukodepleted erythrocytes (LD) versus buffy-coat-depleted packed cells (PC) requires evaluation.
Purpose of the Study:
- To estimate the cost-effectiveness of LD compared to PC in adult patients undergoing valve surgery.
- To analyze healthcare costs and patient longevity from a healthcare perspective.
Main Methods:
- Randomized, double-blind clinical trial data from 474 adult patients.
- Calculation of incremental cost-effectiveness ratio (ICER) per life-year gained.
- Bootstrapping and cost-effectiveness acceptability curves (CEACs) for confidence intervals.
Main Results:
- Leukodepleted erythrocytes (LD) group had a longevity of 11.4 years versus 10.6 years for packed cells (PC).
- Average cost savings per patient with LD were $214 (95% CI = -$1536 to $1964).
- CEACs indicated a 59% probability of LD being cost-saving and 92.7% probability of adoption.
Conclusions:
- Leukodepletion of erythrocytes appears to be a cost-saving strategy in cardiac valve surgery patients.
- Probabilistic analysis did not demonstrate a statistically significant difference between LD and PC.
- Higher cost-savings and health gains were observed in patients receiving four or more transfusions with LD.
Abstract:
Cost-effectiveness of leucodepleted erythrocytes (LD) over buffy-coat-depleted packed cells (PC) is estimated from the primary dataset of a recently reported randomized clinical trial involving valve surgery (+/-CABG) patients. Data on the patient level of 474 adult patients who were randomized double-blind to LD or PC were used in order to calculate the healthcare costs and longevity per patient. The incremental cost-effectiveness ratio (ICER) in net costs per life-year gained was established from the healthcare perspective. Bootstrapping and cost-effectiveness acceptability curves were used in order to determine the confidence interval (CI) of the ICER. The longevity of patients in the PC and LD group was 10.6 and 11.4 years, respectively. Relative to PC, LD yielded an estimated 0.8 (95% CI = -0.27 to 1.84) life-year in the baseline. Adjusted for age and sex differences, health gains for LD are 0.4 life-year gained (95% CI = -0.67 to 1.44). Healthcare costs per patient averaged 10163 US dollars per patient in the PC group and 9949 US dollars in the LD group. Average cost-savings were 214 US dollars (95% CI = -1536 to 1964) per patient. Acceptability curves constructed from bootstrap simulations showed a probability of being cost-saving of 59% for universal leucodepletion from the healthcare perspective. The probability of adopting leucodepletion regardless of the costs reaches 92.7%. LD in patients receiving four or more transfusions showed the highest cost-savings and health gains. Leucodepletion of erythrocytes is a cost-saving strategy in cardiac valve (+/-CABG) patients. However, probablistic analysis failed to show a significant difference with buffy-coat-depleted PC.