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Randomized Controlled Trial
. 2023 Feb 28;9(2):194-202.
doi: 10.1093/ehjqcco/qcac029.

Economic evaluation of restrictive vs. liberal transfusion strategy following acute myocardial infarction (REALITY): trial-based cost-effectiveness and cost-utility analyses

Isabelle Durand-Zaleski  1   2 , Gregory Ducrocq  3 , Maroua Mimouni  1 , Jerome Frenkiel  1 , Cristina Avendano-Solá  4 , Jose R Gonzalez-Juanatey  5 , Emile Ferrari  6 , Gilles Lemesle  7 , Etienne Puymirat  8 , Laurence Berard  9 , Marine Cachanado  9 , Joan Albert Arnaiz  10 , Manuel Martínez-Sellés  11 , Johanne Silvain  12 , Albert Ariza-Solé  13 , Gonzalo Calvo  14 , Nicolas Danchin  8 , Sandra Paco  9 , Elodie Drouet  9 , Helene Abergel  3 , Alexandra Rousseau  9 , Tabassome Simon  9 , Philippe Gabriel Steg  3
Affiliations
Randomized Controlled Trial

Economic evaluation of restrictive vs. liberal transfusion strategy following acute myocardial infarction (REALITY): trial-based cost-effectiveness and cost-utility analyses

Isabelle Durand-Zaleski et al. Eur Heart J Qual Care Clin Outcomes. .

Abstract

Aims: To estimate the cost-effectiveness and cost-utility ratios of a restrictive vs. liberal transfusion strategy in acute myocardial infarction (AMI) patients with anaemia.

Methods and results: Patients (n = 666) with AMI and haemoglobin between 7-8 and 10 g/dL recruited in 35 hospitals in France and Spain were randomly assigned to a restrictive (n = 342) or a liberal (n = 324) transfusion strategy with 1-year prospective collection of resource utilization and quality of life using the EQ5D3L questionnaire. The economic evaluation was based on 648 patients from the per-protocol population. The outcomes were 30-day and 1-year cost-effectiveness, with major adverse cardiovascular events (MACEs) averted as the effectiveness outcome. and a 1-year cost-utility ratio.The 30-day incremental cost-effectiveness ratio was €33 065 saved per additional MACE averted with the restrictive vs. liberal strategy, with an 84% probability for the restrictive strategy to be cost-saving and MACE-reducing (i.e. dominant). At 1 year, the point estimate of the cost-utility ratio was €191 500 saved per quality-adjusted life year gained; however, the cumulated MACE was outside the pre-specified non-inferiority margin, resulting in a decremental cost-effectiveness ratio with a point estimate of €72 000 saved per additional MACE with the restrictive strategy.

Conclusion: In patients with AMI and anaemia, the restrictive transfusion strategy was dominant (cost-saving and outcome-improving) at 30 days. At 1 year, the restrictive strategy remained cost-saving, but clinical non-inferiority on MACE was no longer maintained.

Trial registration: ClinicalTrials.gov Identifier: NCT02648113.

One sentence summary: The use of a restrictive transfusion strategy in patients with acute myocardial infarction is associated with lower healthcare costs, but more evidence is needed to ascertain its long-term clinical impact.

Keywords: Acute myocardial infarction; Cost–effectiveness; Cost–utility; Economics; Transfusion.

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