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Cost‐effectiveness analysis of preoperative transfusion in patients with sickle cell disease using evidence from the TAPS trial
Author(s) -
Spackman Eldon,
Sculpher Mark,
Howard Jo,
Malfroy Moira,
Llewelyn Charlotte,
Choo Louise,
Hodge Renate,
Johnson Tony,
Rees David C.,
Fijnvandraat Karin,
KirbyAllen Melanie,
Davies Sally,
Williamson Lorna
Publication year - 2014
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.12232
Subject(s) - medicine , quality adjusted life year , disease , blood transfusion , cost effectiveness , elective surgery , quality of life (healthcare) , pediatrics , surgery , risk analysis (engineering) , nursing
The study's objective was to assess the cost‐effectiveness of preoperative transfusion compared with no preoperative transfusion in patients with sickle cell disease undergoing low‐ or medium‐risk surgery. Seventy patients with sickle cell disease (Hb SS /Sß 0 thal genotypes) undergoing elective surgery participated in a multicentre randomised trial, T ransfusion A lternatives P reoperatively in S ickle C ell D isease ( TAPS ). Here, a cost‐effectiveness analysis based on evidence from that trial is presented. A decision‐analytic model is used to incorporate long‐term consequences of transfusions and acute chest syndrome. Costs and health benefits, expressed as quality‐adjusted life years ( QALY s), are reported from the ‘within‐trial’ analysis and for the decision‐analytic model. The probability of cost‐effectiveness for each form of management is calculated taking into account the small sample size and other sources of uncertainty. In the range of scenarios considered in the analysis, preoperative transfusion was more effective, with the mean improvement in QALY s ranging from 0.018 to 0.206 per patient, and also less costly in all but one scenario, with the mean cost difference ranging from −£813 to £26. All scenarios suggested preoperative transfusion had a probability of cost‐effectiveness >0.79 at a cost‐effectiveness threshold of £20 000 per QALY .