THE COST-EFFECTIVENESS OF PREOPERATIVE AUTOLOGOUS BLOOD DONATIONS

Background. Since the recognition that human immunodeficiency virus is transmissible by blood transfusion there has been increasing public a nd professional support for autologous blood donations before elective surgery. Autologous blood donation is, however, a more expensive proc ess than the donation of allogeneic blood by community volunteers, Fur thermore, there have been recent improvements in the safety of the vol unteer blood supply, Methods. We used a decision-analysis model to ass ess the cost effectiveness of donating autologous blood for four surgi cal procedures, Cost data were collected from the observation of trans fusion practice at the University of California, Los Angeles, in 1992, Estimates of the risks of transfusion-associated diseases and the cos ts of treating them came from the medical literature. Cost effectivene ss was expressed in dollars per quality-adjusted year of life saved. W e performed sensitivity analyses of the variables in our model and exa mined the effect of strategies suggested to reduce costs. Results. Sub stituting autologous for allogeneic blood resulted in little expected health benefit (0.0002 to 0.00044 quality-adjusted year of life saved) at considerable additional cost ($68 to $4,783 per unit of blood). Th e additional cost of autologous blood was primarily a function of the discarding of units that were donated but not transfused and of a more labor-intensive donation process, The cost-effectiveness values range d from $235,000 to over $23 million per quality-adjusted year of life saved. Conclusions. Given the improved safety of allogeneic transfusio ns today, the increased protection afforded by donating autologous blo od is limited and may not justify the increased cost.