COST-EFFECTIVENESS OF WHITE CELL-REDUCTION FILTERS IN TREATMENT OF ADULT ACUTE MYELOGENOUS LEUKEMIA

The objective of this study was to compare the cost and cost-effective ness of three transfusion strategies in the treatment of acute myeloge nous leukemia: 1) the use of unfiltered pooled platelets until alloimm unization developed and of crossmatch-compatible single-donor platelet s thereafter; 2) the use of filtered blood components until alloimmuni zation occurred and of crossmatch-compatible single-donor platelets th ereafter; and 3) the use of single-donor platelets from the beginning. The data sources were English language articles on transfusion medici ne in acute leukemia and the management of acute leukemia and review o f the transfusion experience at the H. Lee Moffitt Cancer Center. The method was decision analysis with a software program for cost-effectiv eness, sensitivity analysis, threshold evaluation, and Monte Carlo sen sitivity analysis. In the basic models, the total costs of the first, second, and third strategies are, respectively, $12,557.14, $11,406.17 , and $13,016.16 without bone marrow transplant and $14,002.72, $12,28 1.89, and $13,727.48 with bone marrow transplant. The threshold betwee n the first and second strategies in regard to risk of refractoriness to filtered blood components and pooled platelets was 0.30 and 0.27, r espectively, without bone marrow transplant and 0.28 and 0.40 with bon e marrow transplant. According to a Monte Carlo sensitivity analysis o f 500 samples, the second strategy is more cost-effective than the fir st in 76 percent of cases. It is concluded that the use of filtered bl ood components is unlikely to increase the cost of treatment.