The cost-effectiveness of autologous transfusion revisited: implications of an increased risk of bacterial infection with allogeneic transfusion

BACKGROUND: Previous analyses have found autologous transfusion to be very expensive but have not considered avoidance of postoperative bacterial infe ctions as one of its benefits. STUDY DESIGN AND METHODS: A cost-utility analysis using a Markov cohort sim ulation model compared autologous blood transfusion to allogeneic transfusi on in a hypothetical cohort of patients undergoing elective total hip repla cement with respect to discounted quality-adjusted life years (QALYs) and h ealth-care system costs. RESULTS: Assuming a base case rate of serious infection of 3.7 percent, a r elative risk of infection of 1.85, and additional costs of $12,980 per infe ction, autologous transfusion has a cost-effectiveness of $2,470 per QALY. If the relative risk of bacterial infection following allogeneic transfusio n exceeds 1.1, the cost-effectiveness of autologous transfusion is less tha n $50,000 per QALY and if the relative risk exceeds 2.4, autologous transfu sion is dominant, resulting in both lower costs and greater QALYs. If there were no increased risk of transfusion, the cost-effectiveness of autologou s transfusion would be $3,400,000 per QALY. CONCLUSIONS: If there is only a modest increase in the risk of bacterial in fection following allogeneic transfusion, autologous transfusion would resu lt in improved outcomes at a cost of less than $50,000 per QALY. Autologous transfusion would be dominant above a relative risk of infection that is w ithin the range of values observed in randomized controlled trials. However , ii there is no increased risk of bacterial infection, autologous transfus ion would be a very expensive strategy. Until more definitive data are avai lable on the magnitude and costs of this risk, we advise against prematurel y closing the debate about the cost-effectiveness of autologous transfusion .