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Previous Volume 332:719-724 March 16, 1995 Number 11 Next

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ABSTRACT

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 values 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.

Source Information

From the Division of General Internal Medicine, West Los Angeles Veterans Affairs Medical Center and the UCLA School of Medicine (J.E.); the Department of Pathology and Laboratory Medicine (L.P., L.C., S.K.) and the Departments of Medicine and Health Services (A.F., R.B.), UCLA Center for Health Sciences — all in Los Angeles; and RAND, Santa Monica, Calif. (J.E., E.K., C.S., R.B.).

Address reprint requests to Dr. Etchason at the Division of General Internal Medicine, West Los Angeles Veterans Affairs Medical Center, 11301 Wilshire Blvd., Los Angeles, CA 90073.

Full Text of this Article

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Cost Effectiveness of Autologous Blood Donation
Kruskall M. S., Pereira A., Comarow A., Lubarsky D. A., Etchason J., Kleinman S., Kaplan H. S., Rutherford C.
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N Engl J Med 1995; 333:461-463, Aug 17, 1995. Correspondence

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