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Autotransfusion/CS
The 8 evaluations considered cardiac, orthopedic, vascular, and liver
transplantation operations. Six studies were done in the United
States (240-245) and one each in Canada (246), and Sweden (247).
Seven of the evaluations were cost-comparison studies, one was a
cost-utility analysis, and all were published between 1985 and 1995.
Seven of the eight evaluations studied devices that wash and filter
blood retrieved from the operative field while one studied a device
that returned unwashed cells (240). Seven studies directly compared
autotransfusion/CS with allogeneic transfusion (240-246) while one
study combined it with ANH for orthopedic patients (247).
The results of the cost-comparison evaluations of all autotransfusion/CS
varied from a mean saving of $744 per patient (243) to
an additional cost of $587 per patient (244). In general, autotransfusion/CS
was cost saving in operations with high transfusion rates
(e.g. liver transplantation and abdominal aortic aneurysm repair).
However, the cost-utility analysis determined that autotransfusion/
CS use during vascular surgery cost $120,794/QALY (Quality Adjusted
Life Year) for abdominal aortic aneurysm repair and $578,275/
QALY for aortic graft repair of aortoiliac occlusive disease (245).
PAD
The 8 evaluations considered cardiac, orthopedic, vascular, and urologic
operations. All evaluations were published in the 1990’s and all
but one came from the United States (248). Four of the studies were
cost-utility studies using decision analysis (232-234, 249), and the
others were cost-effectiveness (250) or cost-comparison analyses
(239, 248, 251). All studies considered direct costs only.
All studies except that by Roberts (239) found the production and
administration costs of a unit of autologous blood to be greater
than that for allogeneic blood, with the ratio of costs varying from
1.14:1 (233) to 15.1:1 (232). The highest ratios occurred in operations
such as transurethral resection of the prostate in which blood
use is rare (232) and consequently the majority of autologous blood
is not used.
All four cost-utility analyses found predonation of autologous blood
to be more expensive than allogeneic blood, with the cost-utility ratio
depending upon the type of surgery. Operations associated with
considerable blood loss such as coronary artery bypass grafting or