Prospective Economic Evaluation Ancillary to a Trial of Higher versus Lower Hemoglobin Transfusion Thresholds for
John A F Zupancic1,2, Brian C King3,4, Meredith Mowitz5
1Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA, jzupanci@bidmc.harvard.edu.
Insights
Comparing higher versus lower hemoglobin transfusion thresholds for extremely preterm infants shows no significant economic advantage for either strategy. This analysis considered both health sector and societal perspectives, finding costs to be comparable between the two approaches.
Area of Science:
- Neonatal Medicine
- Health Economics
- Clinical Trial Analysis
Background:
- The Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants (HoLLT) trial evaluated transfusion strategies in extremely low birth weight infants.
- This economic evaluation compares the financial implications of higher versus lower hemoglobin transfusion thresholds.
Purpose of the Study:
- To assess the economic impact of different hemoglobin transfusion thresholds in extremely preterm infants.
- To compare costs from both a health sector and a societal perspective.
Main Methods:
- A prospective economic evaluation using patient-level data from the HoLLT clinical trial.
- Costs were analyzed from health sector and societal perspectives in 2020 USD.
- Data sources included hospital finance systems, Medicaid fee schedules, and family questionnaires.
Main Results:
- Mean health sector costs were USD 331,186 (higher threshold) and USD 351,579 (lower threshold), with no statistically significant difference (p=0.085).
- Societal perspective costs also showed no significant difference between the groups (p=0.094).
- High uncertainty was noted in the incremental cost-effectiveness ratios for achieving an additional survivor without neurodevelopmental impairment (NDI).
Conclusions:
- There is no significant economic advantage in choosing between lower or higher hemoglobin transfusion thresholds for extremely preterm infants.
- The economic findings align with previous clinical efficacy results for these transfusion strategies.
Introduction:
The Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants randomized trial compared higher versus lower hemoglobin transfusion thresholds in extremely low birth weight infants. This publication compares the economic implications of the two strategies.
Methods:
We undertook a prospectively planned economic evaluation, using patient-level data from the parent clinical trial. We report costs in 2020 US dollars, from health sector and modified societal perspectives, with a time horizon through the end of clinical follow-up. We derived costs from hospital finance systems, Medicaid fee schedules, family questionnaires, and efficacy from trial data.
Results:
Of the 1,824 patients enrolled at 19 centers in the trial, data were available for 1,305 for analysis from a health sector perspective and 752 for analysis from a societal perspective. The mean cost from the health sector perspective was USD 331,186 per patient in the higher hemoglobin transfusion threshold group and USD 351,579 in the lower hemoglobin transfusion threshold group; the difference was not statistically significant after adjustment for study site and birth weight stratum (p = 0.085). The difference in mean costs from the societal perspective was also not statistically significant (p = 0.094). The incremental cost-effectiveness ratios for adoption of a lower transfusion threshold from health sector and societal perspectives were USD 6,797,666 and USD 5,596,666 per additional survivor without neurodevelopmental impairment, respectively. There was substantial uncertainty in these cost-effectiveness estimates.
Discussion:
Similarly to prior results for clinical efficacy, choosing between a lower or higher hemoglobin transfusion threshold for extremely preterm infants has no significant economic advantage.
