Cost-effectiveness analyses on cell salvage for cesarean delivery to inform national and societal guidelines on obstetric blood management are lacking. We examined the cost-effectiveness of cell salvage strategies in obstetric hemorrhage from a societal perspective.
Markov decision analysis modeling compared the cost-effectiveness of three strategies: use of cell salvage for every cesarean delivery; cell salvage use for high-risk cases; and no cell salvage. A societal perspective and lifetime horizon was assumed for the base case of a 26-year-old primiparous woman presenting for cesarean delivery. Each strategy integrated: probabilities of hemorrhage, hysterectomy, transfusion reactions, emergency procedures, and cell salvage utilization; utilities for quality of life; and costs at the societal level. One-way and Monte Carlo probabilistic sensitivity analyses were performed. A threshold of $100,000 per quality-adjusted life-year gained was used as a cost-effectiveness criterion.
Cell salvage use for cases at high risk for hemorrhage was cost-effective (incremental cost-effectiveness ratio, $34,881 per quality-adjusted life-year gained). Routine cell salvage use for all cesarean deliveries was not cost-effective, costing $415,488 per quality-adjusted life-year gained. Results were not sensitive to individual variation of other model parameters. The probabilistic sensitivity analysis showed that at the $100,000 per quality-adjusted life-year gained threshold, there is >85% likelihood that cell salvage use for cases at high risk for hemorrhage is favorable.