Cost-effectiveness Analysis of Intraoperative Cell Salvage for Obstetric Hemorrhage :

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d894592e159">Background</h5> <p id="P1">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. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d894592e164">Methods</h5> <p id="P2">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. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d894592e169">Results</h5> <p id="P3">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 &gt;85% likelihood that cell salvage use for cases at high risk for hemorrhage is favorable. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d894592e174">Conclusion</h5> <p id="P4">The use of cell salvage for cases at high risk for obstetric hemorrhage is economically reasonable; routine cell salvage use for all cesarean deliveries is not. These findings can inform the development of public policies such as guidelines on management of obstetric hemorrhage. </p> </div>