The Dilemma Between Cost‐Effectiveness and Quality of Care in Transfusion Medicine: The Fiduciary Responsibility of the Physician to the Patient With Regard to Blood Transfusion and Transfusion Alternatives

SUMMARY Cost‐effectiveness analysis (CEA) figures prominently in medical decision‐making and, therefore, must be easily applicable and correctly used. Unfortunately, CEA has the potential to be misleading and in many analyses, including those of transfusion safety initiatives, inappropriate benchmarks have been utilized. Consequently, many transfusion safety initiatives have been incorrectly deemed not cost‐effective and subsequently underutilized, allowing cost to dictate practice. This trend in transfusion medicine creates a dilemma for transfusion medicine professionals, who are torn between their roles as patient advocates and providers of quality patient care and as cost‐conscious laboratory administrators. Given patient demand always for the safest, most effective transfusion therapy regardless of cost and the current medical climate dictated by CEA, who should choose which transfusion safety initiative should be implemented or which transfusion product or alternative should be available? We believe that transfusion medicine professionals must first and foremost uphold their fiduciary responsibility to patients by delivering the safest, most effective therapy.