Potential Cost Saving of Epoetin alfa in Elective Hip or Knee Surgery due to Reduction in Blood Transfusions and Their Side Effects: A Discrete-Event Simulation ModelReportar como inadecuado




Potential Cost Saving of Epoetin alfa in Elective Hip or Knee Surgery due to Reduction in Blood Transfusions and Their Side Effects: A Discrete-Event Simulation Model - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Objectives

Transfusion of allogeneic blood is still common in orthopedic surgery. This analysis evaluates from the perspective of a German hospital the potential cost savings of Epoetin alfa EPO compared to predonated autologous blood transfusions or to a nobloodconservationstrategy allogeneic blood transfusion strategyduring elective hip and knee replacement surgery.

Methods

Individual patients N = 50,000 were simulated based on data from controlled trials, the German DRG institute InEK and various publications and entered into a stochastic model Monte-Carlo of three treatment arms: EPO, preoperative autologous donation and nobloodconservationstrategy. All three strategies lead to a different risk for an allogeneic blood transfusion. The model focused on the costs and events of the three different procedures. The costs were obtained from clinical trial databases, the German DRG system, patient records and medical publications: transfusion allogeneic red blood cells: €320-unit and autologous red blood cells: €250-unit, pneumonia treatment €5,000, and length of stay €300-day. Probabilistic sensitivity analyses were performed to determine which factors had an influence on the model-s clinical and cost outcomes.

Results

At acquisition costs of €200-40,000 IU EPO is cost saving compared to autologous blood donation, and cost-effective compared to a nobloodconservationstrategy. The results were most sensitive to the cost of EPO, blood units and hospital days.

Conclusions

EPO might become an attractive blood conservation strategy for anemic patients at reasonable costs due to the reduction in allogeneic blood transfusions, in the modeled incidence of transfusion-associated pneumonia andthe prolongedlength of stay.



Autor: Jörg Tomeczkowski , Sean Stern, Alfred Müller, Christian von Heymann

Fuente: http://plos.srce.hr/



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