A Health Economic Analysis of Autologous Transfusion

Sonnenberg, Frank A.

doi:10.1159/000064238

Cited by 6 publications

(34 citation statements)

References 59 publications

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“…Previous work has highlighted the value of preoperative education as a way of helping patients to prepare emotionally and practically for colorectal surgery. 100 In other surgeries, inconsistencies between preoperative education and inpatient experiences in colorectal and colonic surgeries have also been previously identified and our findings accord with these. 25,101 Patients undergoing colorectal surgery expressed enthusiasm about working towards their own recovery, 100 a finding reflected in our work.…”

Section: Overview Of Findingssupporting

confidence: 88%

The impact of the enhanced recovery pathway and other factors on outcomes and costs following hip and knee replacement: routine data study

Judge

Carr

Price

et al. 2020

Health Serv Deliv Res

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Background There is limited evidence concerning the effectiveness of enhanced recovery programmes in hip and knee replacement surgery, particularly when applied nationwide across a health-care system. Objectives To determine the effect of hospital organisation, surgical factors and the enhanced recovery after surgery pathway on patient outcomes and NHS costs of hip and knee replacement. Design (1) Statistical analysis of national linked data to explore geographical variations in patient outcomes of surgery. (2) A natural experimental study to determine clinical effectiveness of enhanced recovery after surgery. (3) A qualitative study to identify barriers to, and facilitators of, change. (4) Health economics analysis to establish NHS costs and cost-effectiveness. Setting Data from the National Joint Registry, linked to English Hospital Episode Statistics and patient-reported outcome measures in both the geographical variation and natural experiment studies, together with the economic evaluation. The ethnographic study took place in four hospitals in a region of England. Participants Qualitative study – 38 health professionals working in hip and knee replacement services in secondary care and 37 patients receiving hip or knee replacement. Interventions Natural experiment – implementation of enhanced recovery after surgery at each hospital between 2009 and 2011. Enhanced recovery after surgery is a complex intervention focusing on several areas of patients’ care pathways through surgery: preoperatively (patient is in best possible condition for surgery), perioperatively (patient has best possible management during and after operation) and postoperatively (patient experiences best rehabilitation). Main outcome measures Patient-reported pain and function (Oxford Hip Score/Oxford Knee Score); 6-month complications; length of stay; bed-day costs; and revision surgery within 5 years. Results Geographical study – there are potentially unwarranted variations in patient outcomes of hip and knee replacement surgery. This variation cannot be explained by differences in patients, case mix, surgical or hospital organisational factors. Qualitative – successful implementation depends on empowering patients to work towards their recovery, providing post-discharge support and promoting successful multidisciplinary team working. Care processes were negotiated between patients and health-care professionals. ‘Good care’ remains an aspiration, particularly in the post-discharge period. Natural experiment – length of stay has declined substantially, pain and function have improved, revision rates are in decline and complication rates remain stable. The introduction of a national enhanced recovery after surgery programme maintained improvement, but did not alter the rate of change already under way. Health economics – costs are high in the year of joint replacement and remain higher in the subsequent year after surgery. There is a strong economic incentive to identify ways of reducing revisions and complications following joint replacement. Published cost-effectiveness evidence supports enhanced recovery pathways as a whole. Limitations Short duration of follow-up data prior to enhanced recovery after surgery implementation and missing data, particularly for hospital organisation factors. Conclusion No evidence was found to show that enhanced recovery after surgery had a substantial impact on longer-term downwards trends in costs and length of stay. Trends of improving outcomes were seen across all age groups, in those with and without comorbidity, and had begun prior to the formal enhanced recovery after surgery roll-out. Reductions in length of stay have been achieved without adversely affecting patient outcomes, yet, substantial variation remains in outcomes between hospital trusts. Future work There is still work to be done to reduce and understand unwarranted variations in outcome between individual hospitals. Study registration This study is registered as PROSPERO CRD42017059473. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 4. See the NIHR Journals Library website for further project information.

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Section: Overview Of Findingssupporting

confidence: 88%

The impact of the enhanced recovery pathway and other factors on outcomes and costs following hip and knee replacement: routine data study

Judge

Carr

Price

et al. 2020

Health Serv Deliv Res

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show abstract

“…it was more effective and saved costs, when a certain assumption was made. This assumption referred to the immunosuppressive effect of allogeneic transfusion and implied that, by avoiding this effect, PABD would lead to a reduction in postoperative bacterial infections 9,12,14,15 . For instance, in the analysis by Sonnenberg et al.…”

Section: Resultsmentioning

confidence: 99%

“…Ten studies were identified, [6][7][8][9][10][11][12][13][14][15][16] most of which were conducted in the USA. The majority of these studies adopted the societal perspective, although only direct costs were estimated (Table 1).…”

Section: Preoperative Autologous Blood Donationmentioning

confidence: 99%

“…This assumption referred to the immunosuppressive effect of allogeneic transfusion and implied that, by avoiding this effect, PABD would lead to a reduction in postoperative bacterial infections. 9,12,14,15 For instance, in the analysis by Sonnenberg et al , 12 it was concluded that PABD was dominant when the risk of a postoperative infectious complication after allogeneic transfusion was 2.4 times as high as that after autologous transfusion ( Figure 1). When no risk difference was assumed (relative risk = 1.0), an unacceptable cost-effectiveness ratio of $3,400,000 per QALY was calculated.…”

Section: Preoperative Autologous Blood Donationmentioning

confidence: 99%

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The cost‐effectiveness of autologous transfusion alternatives: an update and reappraisal

Karger

Kretschmer

2007

Transfus Alt Transfus Med

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SUMMARY There is still an ongoing debate whether autologous transfusion methods (ATM) are cost‐effective when compared with each other or with other medical interventions. A search on MEDLINE and in the British National Health Service Economic Evaluation Database was conducted to retrieve cost‐effectiveness analyses focusing on preoperative autologous blood donation (PABD), acute normovolemic hemodilution (ANH) or perioperative blood salvage (PBS). The search covered the years from 1991 to 2006. The quality of retrieved papers was assessed using published criteria for the evaluation of economic analyses of health‐care measures. Twenty‐six studies were identified: ten for PABD, four for ANH, seven for PBS and five which evaluated strategies combining different ATM. Nineteen studies were conducted in the USA, including most of the PABD studies. Only one study included indirect costs in its cost estimates. The majority of analyses were based on suboptimal study designs. Only six studies employed randomized controlled trials, in most of which avoidance of allogeneic transfusion was chosen as the effectiveness parameter. Ten studies used decision analysis models, calculating cost‐effectiveness ratios based on quality‐adjusted life‐years. These included eight PABD studies and two PBS studies. The assumptions needed for the models were often either outdated or derived from unsystematic reviews of the pertinent literature. In conclusion, economic analyses of ATM are heterogeneous with respect to several aspects of study design. The currently available scientific evidence is of limited quality because of considerable uncertainties in estimates of several key variables thought to substantially affect the results of economic analyses.

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“…Details of the previous analysis may be found in [5]. A more detailed description of our updated model may be found in [6].…”

Section: Overview and Assumptionsmentioning

confidence: 99%

Autologous Transfusion - a Reasonable Measure under the Principles of Health Economics?

Fa¹

2003

Anasthesiol Intensivmed Notfallmed Schmerzthe

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A Health Economic Analysis of Autologous Transfusion

Cited by 6 publications

References 59 publications

The impact of the enhanced recovery pathway and other factors on outcomes and costs following hip and knee replacement: routine data study

The impact of the enhanced recovery pathway and other factors on outcomes and costs following hip and knee replacement: routine data study

The cost‐effectiveness of autologous transfusion alternatives: an update and reappraisal

Autologous Transfusion - a Reasonable Measure under the Principles of Health Economics?

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