Cost-effectiveness of cell salvage and donor blood transfusion during caesarean section: results from a randomised controlled trial
Publisher
DOI
10.1136/bmjopen-2018-022352
Journal
BMJ Open
ISSN
2044-6055
Metadata
Show full item recordAbstract
Objectives To evaluate the cost-effectiveness of routine
use of cell salvage during caesarean section in mothers
at risk of haemorrhage compared with current standard
of care.
Design Model-based cost-effectiveness evaluation
alongside a multicentre randomised controlled trial. Three
main analyses were carried out on the trial data: (1) based
on the intention-to-treat principle; (2) based on the perprotocol principle; (3) only participants who underwent an
emergency caesarean section.
Setting 26 obstetric units in the UK.
Participants 3028 women at risk of haemorrhage
recruited between June 2013 and April 2016.
Interventions Cell salvage (intervention) versus routine
care without salvage (control).
Primary outcome measures Cost-effectiveness based
on incremental cost per donor blood transfusion avoided.
Results In the intention-to-treat analysis, the mean
difference in total costs between cell salvage and
standard care was £83. The estimated incremental costeffectiveness ratio (ICER) was £8110 per donor blood
transfusion avoided. For the per-protocol analysis, the
mean difference in total costs was £92 and the ICER was
£8252. In the emergency caesarean section analysis, the
mean difference in total costs was £55 and the ICER was
£13 713 per donor blood transfusion avoided. This ICER
is driven by the increased probability that these patients
would require a higher level of postoperative care and
additional surgeries. The results of these analyses were
shown to be robust for the majority of deterministic
sensitivity analyses.
Conclusions The results of the economic evaluation
suggest that while routine cell salvage is a marginally
more effective strategy than standard care in avoiding a
donor blood transfusion, there is uncertainty in relation
to whether it is a less or more costly strategy. The lack of
long-term data on the health and quality of life of patients
in both arms of the trial means that further research is
needed to fully understand the cost implications of both
strategies.
Authors
HOOPER, R; LANZ, D; DODDS, J; KHAN, KCollections
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