Potential Cost Saving of Epoetin alfa in Elective Hip or Knee Surgery due to Reduction in Blood Transfusions and Their Side Effects: A Discrete-Event Simulation Model

Abstract

ObjectivesTransfusion of allogeneic blood is still common in orthopedic surgery. This analysis evaluates from the perspective of a German hospital the potential cost savings of Epoetin alfa (EPO) compared to predonated autologous blood transfusions or to a nobloodconservationstrategy (allogeneic blood transfusion strategy)during elective hip and knee replacement surgery.MethodsIndividual patients (N = 50,000) were simulated based on data from controlled trials, the German DRG institute (InEK) and various publications and entered into a stochastic model (Monte-Carlo) of three treatment arms: EPO, preoperative autologous donation and nobloodconservationstrategy. All three strategies lead to a different risk for an allogeneic blood transfusion. The model focused on the costs and events of the three different procedures. The costs were obtained from clinical trial databases, the German DRG system, patient records and medical publications: transfusion (allogeneic red blood cells: €320/unit and autologous red blood cells: €250/unit), pneumonia treatment (€5,000), and length of stay (€300/day). Probabilistic sensitivity analyses were performed to determine which factors had an influence on the model's clinical and cost outcomes.ResultsAt acquisition costs of €200/40,000 IU EPO is cost saving compared to autologous blood donation, and cost-effective compared to a nobloodconservationstrategy. The results were most sensitive to the cost of EPO, blood units and hospital days.ConclusionsEPO might become an attractive blood conservation strategy for anemic patients at reasonable costs due to the reduction in allogeneic blood transfusions, in the modeled incidence of transfusion-associated pneumonia andthe prolongedlength of stay.

Ferric carboxymaltose with or without erythropoietin in anemic patients with hip fracture: a randomized clinical trial

“…Nevertheless, and in spite of the differences between both studies, in ours, we did not detect any supplementary benefit in RBC transfusion reduction, in the subgroups of intracapsular HF, or in those patients with highest Hb levels (in our case those with inclusion Hb level ≥ 115 g/L). Data from our study also contrast with the established benefit of preoperative EPO and IV iron in patients undergoing elective major orthopedic procedures . Nevertheless, results obtained in the previous trials are difficult to extrapolate to patients with HF.…”

“…[25][26][27][28][29] Additionally, the benefits of perioperative use of erythropoietin (EPO) with or without IV iron in major orthopedic procedures are well established. [30][31][32][33][34][35][36][37][38][39][40][41] This evidence could be promising for patients with HF. We hypothesized if the sum up of EPO with the concomitant use of FCM could serve to save blood transfusions in patients with HF.…”

Predictors of perioperative blood transfusions in patients with chronic kidney disease undergoing elective knee and hip arthroplasty

“…A recent study using computer modelling, demonstrated the cost effectiveness of erythropoeitin therapy over ABT if initiated at preoperative haemoglobin between 100 and 130 g/L. 24 Other factors, presumed or known to be associated with the use of ABT, such as revision surgery, duration, age, gender, hip versus knee arthroplasty and use of anticoagulants or antiplatelet agents, 25 were not significantly associated with ABT utilization in our cohort. Although the ratio of hip/knee surgery was reversed in CKD patients compared with controls, there was no difference in the use of ABT between those having hip or knee replacement.…”

“…While this was not explored in the present study, we could anticipate that even if low‐normal haemoglobin levels are tackled by strategies that have been shown to be effective in patients with CKD, including preoperative intravenous iron with or without erythropoietin, the use of ABT in this cohort would be reduced. A recent study using computer modelling, demonstrated the cost effectiveness of erythropoeitin therapy over ABT if initiated at preoperative haemoglobin between 100 and 130 g/L …”

Conséquences de la pression économique sur les pratiques médicales en transfusion sanguine

“…La stratégie d'administration d'Epo est largement préférée à la transfusion autologue, et serait efficiente par rapport à une stratégie de transfusion conventionnelle [22,23]. Le problème est que les différentes stratégies sont en général comparées deux à deux, et qu'il est difficile de savoir si, pour une chirurgie programmée, l'administration d'Epo est préférable à l'utilisation des seuils transfusionnel ou le monitoring de l'Hb par exemple.…”