FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

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

	Full Text PDF Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

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

Related Letters:

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.
Extract | Full Text  
N Engl J Med 1995; 333:461-463, Aug 17, 1995. Correspondence

This article has been cited by other articles:

• Martinez, V., Monsaingeon-Lion, A., Cherif, K., Judet, T., Chauvin, M., Fletcher, D. (2007). Transfusion strategy for primary knee and hip arthroplasty: impact of an algorithm to lower transfusion rates and hospital costs. Br J Anaesth 99: 794-800 [Abstract] [Full Text]  
• Millett, P. J., Porramatikul, M., Chen, N., Zurakowski, D., Warner, J. J.P. (2006). Analysis of Transfusion Predictors in Shoulder Arthroplasty. JBJS 88: 1223-1230 [Abstract] [Full Text]  
• Walmsley, P. J., Kelly, M. B., Hill, R. M. F., Brenkel, I. (2005). A prospective, randomised, controlled trial of the use of drains in total hip arthroplasty. J Bone Joint Surg Br 87-B: 1397-1401 [Abstract] [Full Text]  
• Morgan, T. O. (2005). Cost, quality, and risk: Measuring and stopping the hidden costs of coronary artery bypass graft surgery. Am J Health Syst Pharm 62: S2-S5 [Abstract] [Full Text]  
• Custer, B., Johnson, E. S., Sullivan, S. D., Hazlet, T. K., Ramsey, S. D., Murphy, E. L., Busch, M. P. (2005). Community Blood Supply Model: Development of a New Model to Assess the Safety, Sufficiency, and Cost of the Blood Supply. Med Decis Making 25: 571-582 [Abstract]  
• Madjdpour, C., Spahn, D. R. (2005). Allogeneic red blood cell transfusions: efficacy, risks, alternatives and indications. Br J Anaesth 95: 33-42 [Abstract] [Full Text]  
• Shander, A., Moskowitz, D., Rijhwani, T. S. (2005). The Safety and Efficacy of "Bloodless" Cardiac Surgery. SEMIN CARDIOTHORAC VASC ANESTH 9: 53-63 [Abstract]  
• Spiess, B. D. (2004). Transfusion of Blood Products Affects Outcome in Cardiac Surgery. SEMIN CARDIOTHORAC VASC ANESTH 8: 267-281 [Abstract]  
• Pierson, J. L., Hannon, T. J., Earles, D. R. (2004). A Blood-Conservation Algorithm to Reduce Blood Transfusions After Total Hip and Knee Arthroplasty. JBJS 86: 1512-1518 [Abstract] [Full Text]  
• Couvret, C., Laffon, M., Baud, A., Payen, V., Burdin, P., Fusciardi, J. (2004). A Restrictive Use of Both Autologous Donation and Recombinant Human Erythropoietin Is an Efficient Policy for Primary Total Hip or Knee Arthroplasty. Anesth. Analg. 99: 262-271 [Abstract] [Full Text]  
• Karski, J. M., Balatbat, J. T. (2003). Blood Conservation Strategies in Cardiac Surgery. SEMIN CARDIOTHORAC VASC ANESTH 7: 175-188 [Abstract]  
• Howe, C., Paschall, C., Panwalkar, A., Beal, J., Potti, A. (2003). A Model for Clinical Estimation of Perioperative Hemorrhage. CLIN APPL THROMB HEMOST 9: 131-135 [Abstract]  
• Tengs, T. O., Lin, T. H. (2002). A Meta-Analysis of Utility Estimates for HIV/AIDS. Med Decis Making 22: 475-481 [Abstract]  
• Calvert, H., Jodrell, D. I, Cassidy, J., Harris, A. L, Messori, A., Trippoli, S., Vaiani, M., Garattini, S., Bertele', V. (2002). Efficacy, safety, and cost of new anticancer drugs. BMJ 325: 1302-1302 [Full Text]  
• Billote, D. B., Glisson, S. N., Green, D., Wixson, R. L. (2002). A Prospective, Randomized Study of Preoperative Autologous Donation for Hip Replacement Surgery. JBJS 84: 1299-1304 [Abstract] [Full Text]  
• Couture, D. E., Ellegala, D. B., Dumont, A. S., Mintz, P. D., Kassell, N. F. (2002). Blood Use in Cerebrovascular Neurosurgery. Stroke 33: 994-997 [Abstract] [Full Text]  
• Couvret, C., Tricoche, S., Baud, A., Dabo, B., Buchet, S., Palud, M., Fusciardi, J. (2002). The Reduction of Preoperative Autologous Blood Donation for Primary Total Hip or Knee Arthroplasty: The Effect on Subsequent Transfusion Rates. Anesth. Analg. 94: 815-823 [Abstract] [Full Text]  
• Wang, G. J., Hungerford, D. S., Savory, C. G., Rosenberg, A. G., Mont, M. A., Burks, S. G., Mayers, S. L., Spotnitz, W. D. (2001). Use of Fibrin Sealant to Reduce Bloody Drainage and Hemoglobin Loss After Total Knee Arthroplasty : A Brief Note on a Randomized Prospective Trial. JBJS 83: 1503-1505 [Abstract] [Full Text]  
• Grant, F. C., Laupacis, A., O'Connor, A. M., Rubens, F., Robblee, J. (2001). Evaluation of a decision aid for patients considering autologous blood donation before open-heart surgery. CMAJ 164: 1139-1144 [Abstract] [Full Text]  
• Vamvakas, E. C., Blajchman, M. A. (2001). Deleterious clinical effects of transfusion-associated immunomodulation: fact or fiction?. Blood 97: 1180-1195 [Full Text]  
• Dahmani, S., Orliaguet, G. A., Meyer, P. G., Blanot, S., Renier, D., Carli, P. A. (2000). Perioperative blood salvage during surgical correction of craniosynostosis in infants. Br J Anaesth 85: 550-555 [Abstract] [Full Text]  
• Murkin, J. M., Haig, G. M., Beer, K. J., McCutchen, J., Comunale, M. E., Hall, R., Ruzicka, B. B. (2000). Aprotinin Decreases Exposure to Allogeneic Blood During Primary Unilateral Total Hip Replacement. JBJS 82: 675-675 [Abstract] [Full Text]  
• HATZIDAKIS, A. M., MENDLICK, M. R., McKILLIP, T., REDDY, R. L., GARVIN, K. L. (2000). Preoperative Autologous Donation for Total Joint Arthroplasty. An Analysis of Risk Factors for Allogenic Transfusion. JBJS 82: 89-100 [Abstract] [Full Text]  
• McFarland, J. G. (1999). Perioperative Blood Transfusions: Indications and Options. Chest 115 : 113S-121S [Abstract] [Full Text]  
• Savarese, D., Waitkus, H., Stewart, F. M., Callery, M. (1999). Bloodless Medicine and Surgery. J Intensive Care Med 14: 20-33  
• BIERBAUM, B. E., CALLAGHAN, J. J., GALANTE, J. O., RUBASH, H. E., TOOMS, R. E., WELCH, R. B. (1999). An Analysis of Blood Management in Patients Having a Total Hip or Knee Arthroplasty. JBJS 81: 2-10 [Abstract] [Full Text]  
• Hazen, G. B., Pellissier, J. M., Sounderpandian, J. (1998). Stochastic-Tree Models in Medical Decision Making. Interfaces 28: 64-80 [Abstract]  
• Shekelle, P. G., Kahan, J. P., Bernstein, S. J., Leape, L. L., Kamberg, C. J., Park, R.E. (1998). The Reproducibility of a Method to Identify the Overuse and Underuse of Medical Procedures. NEJM 338: 1888-1895 [Abstract] [Full Text]  
• Kilgore, M. L., Pacifico, A. D. (1998). Shed Mediastinal Blood Transfusion After Cardiac Operations: A Cost-Effectiveness Analysis. Ann. Thorac. Surg. 65: 1248-1254 [Abstract] [Full Text]  
• Forgie, M. A., Wells, P. S., Laupacis, A., Fergusson, D., for the International Study of Perioperative Trans, (1998). Preoperative Autologous Donation Decreases Allogeneic Transfusion but Increases Exposure to All Red Blood Cell Transfusion: Results of a Meta-analysis. Arch Intern Med 158: 610-616 [Abstract] [Full Text]  
• Merin, R. G., Brown, J. L., Watson, D., Laurenson, I. F., Nimmo, A. F., Potyk, D., Stichtenoth, D. O., Frolich, J. C., Blumberg, N., Bliss, M. R., Wiklund, R. A., Rosenbaum, S. H. (1998). Anesthesiology. NEJM 338: 684-687 [Full Text]  
• Wiklund, R. A., Rosenbaum, S. H. (1997). Anesthesiology- First of Two Parts. NEJM 337: 1132-1141 [Full Text]  
• Cazzola, M., Mercuriali, F., Brugnara, C. (1997). Use of Recombinant Human Erythropoietin Outside the Setting of Uremia. Blood 89: 4248-4267 [Full Text]  
• Goodnough, L. T., Monk, T. G., Andriole, G. L. (1997). Erythropoietin Therapy. NEJM 336: 933-938 [Full Text]  
• SPARLING, E. A., NELSON, C. L., LAVENDER, R., SMITH, J. (1996). The Use of Erythropoietin in the Management of Jehovah's Witnesses Who Have Revision Total Hip Arthroplasty. JBJS 78: 1548-52 [Abstract] [Full Text]  
• Kanter, M. H., van Maanen, D., Anders, K. H., Castro, F., Mya, W. W., Clark, K. (1996). Preoperative Autologous Blood Donations Before Elective Hysterectomy. JAMA 276: 798-801 [Abstract]  
• LEMOS, M. J., HEALY, W. L. (1996). Current Concepts Review - Blood Transfusion in Orthopaedic Operations. JBJS 78: 1260-71 [Full Text]  
• Richtsmeier, W. J., Johns, M. E. (1996). Otolaryngology-Head and Neck Surgery. JAMA 275: 1838-1839 [Abstract]  
• Brasel, K. J., Weigelt, J. A. (1996). Blunt Thoracic Aortic Trauma: A Cost-Utility Approach for Injury Detection. Arch Surg 131: 619-626 [Abstract]  
• Chang, R. W., Pellissier, J. M., Hazen, G. B. (1996). A Cost-effectiveness Analysis of Total Hip Arthroplasty for Osteoarthritis of the Hip. JAMA 275: 858-865 [Abstract]  
• Kruskall, M. S., Pereira, A., Comarow, A., Lubarsky, D. A., Etchason, J., Kleinman, S., Kaplan, H. S., Rutherford, C. (1995). Cost Effectiveness of Autologous Blood Donation. NEJM 333: 461-463 [Full Text]  
• Lee, T. H. (1995). Cost Effectiveness of Tissue Plasminogen Activator. NEJM 332: 1443-1444 [Full Text]  
• Rutherford, C. J., Kaplan, H. S. (1995). Autologous Blood Donation -- Can We Bank on It?. NEJM 332: 740-742 [Full Text]