THE COST-EFFECTIVENESS OF PREOPERATIVE AUTOLOGOUS BLOOD DONATION FOR TOTAL HIP AND KNEE REPLACEMENT

Although the frequency of preoperative autologous blood donation is in creasing dramatically, the economic implications of its use remain lar gely unexplored. Decision analysis was used to calculate the cost-effe ctiveness of autologous blood donation for hip and knee replacement. C ost-effectiveness, expressed as cost per quality-adjusted year of life saved, was based on observed red cell use in 629 patients undergoing surgery at two tertiary-care centers. Autologous blood donation for bi lateral and revision joint replacement cost $40,000 per quality-adjust ed year of life saved at Center 1 and $241,000 at Center 2. Autologous blood donation for primary unilateral hip replacement cost $373,000 p er quality-adjusted year of life saved at Center 1 and $740,000 at Cen ter 2. Autologous blood donation was least cost-effective for primary unilateral knee replacement ($1,147,000/quality-adjusted year of life saved at Center 1 and $1,467,000/year at Center 2). Differences betwee n autologous blood collections and transfusion requirements explained variations among procedures in the cost-effectiveness of autologous bl ood donation. Higher transfusion rates in autologous blood donors than in nondonors accounted for the poorer cost-effectiveness of autologou s blood donation at Center 2 than at Center 1. Autologous blood donati on is not as cost-effective as most accepted medical practices. Its co st-effectiveness can be improved substantially by the avoidance of ove rcollection and overtransfusion of autologous blood.