Document 0552
 DOCN  M9550552
 TI    The cost effectiveness of preoperative autologous blood donations [see
       comments]
 DT    9505
 AU    Etchason J; Petz L; Keeler E; Calhoun L; Kleinman S; Snider C; Fink A;
       Brook R; Division of General Internal Medicine, West Los Angeles
       Veterans; Affairs Medical Center, CA 90073.
 SO    N Engl J Med. 1995 Mar 16;332(11):719-24. Unique Identifier : AIDSLINE
       MED/95157592
 CM    Comment in: N Engl J Med 1995 Mar 16;332(11):740-2
 AB    BACKGROUND. Since the recognition that human immunodeficiency virus is
       transmissible by blood transfusion there has been increasing public and
       professional support for autologous blood donations before elective
       surgery. Autologous blood donation is, however, a more expensive process
       than the donation of allogeneic blood by community volunteers.
       Furthermore, there have been recent improvements in the safety of the
       volunteer blood supply. METHODS. We used a decision-analysis model to
       assess the cost effectiveness of donating autologous blood for four
       surgical procedures. Cost data were collected from the observation of
       transfusion practice at the University of California, Los Angeles, in
       1992. Estimates of the risks of transfusion-associated diseases and the
       costs of treating them came from the medical literature. Cost
       effectiveness was expressed in dollars per quality-adjusted year of life
       saved. We performed sensitivity analyses of the variables in our model
       and examined the effect of strategies suggested to reduce costs.
       RESULTS. Substituting autologous for allogeneic blood resulted in little
       expected health benefit (0.0002 to 0.00044 quality-adjusted year of life
       saved) at considerable additional cost ($68 to $4,783 per unit of
       blood). The additional cost of autologous blood was primarily a function
       of the discarding of units that were donated but not transfused and of a
       more labor-intensive donation process. The cost-effectiveness ratios
       ranged from $235,000 to over $23 million per quality-adjusted year of
       life saved. CONCLUSIONS. Given the improved safety of allogeneic
       transfusions today, the increased protection afforded by donating
       autologous blood is limited and may not justify the increased cost.
 DE    Blood Transfusion/ECONOMICS  Blood Transfusion, Autologous/*ECONOMICS
       Cost Savings  Cost-Benefit Analysis  Decision Support Techniques  Human
       Preoperative Care/*ECONOMICS  Sensitivity and Specificity  Support,
       Non-U.S. Gov't  Support, U.S. Gov't, P.H.S.  Transplantation,
       Homologous/ECONOMICS  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).