Potential cost saving of Epoetin alfa in elective hip or knee surgery due to reduction in blood transfusions and their side effects: a discrete-event simulation model

Abstract

Objectives: Transfusion of allogeneic blood is still common in orthopedic surgery. This analysis evaluates from the perspective of a German hospital the potential cost savings of Epoetin alfa (EPO) compared to predonated autologous blood transfusions or to a nobloodconservationstrategy (allogeneic blood transfusion strategy)during elective hip and knee replacement surgery.

Methods: Individual patients (N = 50,000) were simulated based on data from controlled trials, the German DRG institute (InEK) and various publications and entered into a stochastic model (Monte-Carlo) of three treatment arms: EPO, preoperative autologous donation and nobloodconservationstrategy. All three strategies lead to a different risk for an allogeneic blood transfusion. The model focused on the costs and events of the three different procedures. The costs were obtained from clinical trial databases, the German DRG system, patient records and medical publications: transfusion (allogeneic red blood cells: €320/unit and autologous red blood cells: €250/unit), pneumonia treatment (€5,000), and length of stay (€300/day). Probabilistic sensitivity analyses were performed to determine which factors had an influence on the model's clinical and cost outcomes.

Results: At acquisition costs of €200/40,000 IU EPO is cost saving compared to autologous blood donation, and cost-effective compared to a nobloodconservationstrategy. The results were most sensitive to the cost of EPO, blood units and hospital days.

Conclusions: EPO might become an attractive blood conservation strategy for anemic patients at reasonable costs due to the reduction in allogeneic blood transfusions, in the modeled incidence of transfusion-associated pneumonia andthe prolongedlength of stay.

Figure 1. Algorithm of Patient Creation and of Modeled Blood Transfusion.

Figure 2. Incremental costs of ABT vs. EPO strategy – Sensitivity Analyses: Most Influential Parameters (Factor 1.11 and 1.29 are referring to lower and upper 95% Confidence interval).

Figure 3. ABT vs. EPO – Sensitivity Analyses: Other Influential Parameters.

Figure 4. PAD vs. EPO – Sensitivity Analyses: PAD Parameters.

Figure 5. Sensitivity analysis –ABT vs. EPO by preoperative Hb level subgroups.

Figure 6. Sensitivity analysis –PAD vs. EPO by preoperative Hb level subgroups.