Economic analysis of erythropoietin use in orthopaedic surgery

The aim was to assess the cost-effectiveness of erythropoietin (EPO) to red uce patients' exposure to perioperative allogenic blood products in orthopa edic surgery. The use of EPO was assessed for EPO used alone and for EPO to augment preoperative autologous donation (PAD). A decision analytical model was designed incorporating (i) the risk of rece iving allogeneic blood, (ii) the costs of blood products, (iii) the likelih ood of developing transfusion-related diseases, (iv) the costs of transfusi on-related diseases, (v) the impact of transfusion-related diseases on pati ent morbidity and mortality and (vi) the effect of EPO upon the probability of transfusion. The efficacy of EPO was derived from data from a metaanaly sis of published randomized trials. Estimates for the other parameters were obtained by a systematic review of the literature. EPO alone led to only modest incremental benefit compared to no interventio n for orthopaedic surgery (0.000024 life-years gained per patient). As an a ugmentation to PAD, EPO also led to modest benefits (0.000006 life-years ga ined per patient). For EPO compared to no intervention, the incremental cos t per life-year gained was $66 million (Canadian). For EPO to augment PAD, the incremental cost per life-year gained was $329 million (Canadian). Deta iled sensitivity analysis did not reveal any circumstances in which the cos t-effectiveness ratios reached a level generally considered attractive. On the basis of cost-effectiveness, the use of EPO to reduce perioperative allogeneic transfusions in orthopaedic surgery did not meet criteria conven tionally considered acceptable.