Mortality risks, costs, and decision making in transfusion medicine

Traditional quality-adjusted life year (QALY) cost analysis is complex and assigns arbitrary dollar values to catastrophic outcomes such as death. Ana lysis of transfusion medicine technologies by an alternative approach that focuses on costs to avoid fatal outcomes might be a useful adjunct to QALY analysis for allocating limited financial resources. We estimated the cost per death averted for the following interventions: apheresis platelets vs r andom platelets, solvent detergent-treated plasma vs untreated plasma, and leukocyte-reduced vs unmodified transfusions in cardiac surgery. As a contr ol, similar data were calculated for current donor viral testing. The estim ated incremental costs per death avoided were as follows: single-donor aphe resis platelets, $15 million; solvent detergent plasma, $17 million; leukoc yte-reduced transfusions in cardiac surgery $11,000; HIV-1 antibody testing , $22,000; and HIV-1 antigen testing, $3.9 million. The estimated number of deaths averted per year in our hospital were as follows: apheresis platele ts, 0.1 solvent detergent plasma, 0.044; leukocyte-reduced transfusions, 14 ; HIV-1 antibody testing 6.0; and HIV-1 antigen testing, 0.033. HIV-1 antib ody testing and leukocyte-reduced transfusions in cardiac surgery are compa rably cost-efficient means of averting mortality in patients receiving tran sfusions. Solvent detergent plasma and apheresis platelets are comparativel y expensive approaches to reducing mortality from transfusion complications .