Cost-effectiveness of cell salvage and donor blood transfusion during caesarean section: results from a randomised controlled trial

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Cost-effectiveness of cell salvage and donor blood transfusion during caesarean section : results from a randomised controlled trial. / McLoughlin, Carol; Roberts, Tracy; Jackson, Louise; Moore, Philip; Wilson, Matthew; Hooper, Richard; Allard, Shubha; Wrench, Ian; Beresford, Lee; Geoghegan, James; Daniels, Jane P.; Catling, Sue; Clark, Vicki A.; Ayuk, Paul; Robson, Stephen; Gao Smith, Fang; Hogg, Matthew; Lanz, Doris; Dodds, Julie; Khan, Khalid.

In: BMJ open, Vol. 9, No. 2, bmjopen-2018-022352, 09.02.2019.

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McLoughlin, C, Roberts, T, Jackson, L, Moore, P, Wilson, M, Hooper, R, Allard, S, Wrench, I, Beresford, L, Geoghegan, J, Daniels, JP, Catling, S, Clark, VA, Ayuk, P, Robson, S, Gao Smith, F, Hogg, M, Lanz, D, Dodds, J & Khan, K 2019, 'Cost-effectiveness of cell salvage and donor blood transfusion during caesarean section: results from a randomised controlled trial' BMJ open, vol. 9, no. 2, bmjopen-2018-022352. https://doi.org/10.1136/bmjopen-2018-022352

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McLoughlin, Carol ; Roberts, Tracy ; Jackson, Louise ; Moore, Philip ; Wilson, Matthew ; Hooper, Richard ; Allard, Shubha ; Wrench, Ian ; Beresford, Lee ; Geoghegan, James ; Daniels, Jane P. ; Catling, Sue ; Clark, Vicki A. ; Ayuk, Paul ; Robson, Stephen ; Gao Smith, Fang ; Hogg, Matthew ; Lanz, Doris ; Dodds, Julie ; Khan, Khalid. / Cost-effectiveness of cell salvage and donor blood transfusion during caesarean section : results from a randomised controlled trial. In: BMJ open. 2019 ; Vol. 9, No. 2.

Bibtex

@article{08a2fb31386446dc9a2a62fcc542a825,
title = "Cost-effectiveness of cell salvage and donor blood transfusion during caesarean section: results from a randomised controlled trial",
abstract = "Objectives: To evaluate the cost-effectiveness of routine use of cell salvage during caesarean section in mothers at risk of haemorrhage compared with current standard of care.Design: Model-based cost-effectiveness evaluation alongside a multicentre randomised controlled trial (RCT). Three main analyses were carried out on the trial data: (1) based on the intention to treat principle; (2) based on the per protocol principle; (3) only participants who underwent an emergency caesarean section.Setting: 26 obstetric units in the UK.Participants: 3028 women at risk of haemorrhage recruited between June 2013 and April 2016. Interventions: Cell salvage (intervention) versus routine care without salvage (control).Primary outcome measures: Cost-effectiveness based on incremental cost per donor blood transfusion avoided.Results: In the intention to treat analysis the mean difference in total costs between cell salvage and standard care was £83. The estimated incremental cost-effectiveness ratio (ICER) was £8,110 per donor blood transfusion avoided. For the per protocol analysis the mean difference in total costs was £92 and the ICER was £8,252. In the emergency caesarean section analysis the mean difference in total costs was £55 and the ICER was £13,713 per donor blood transfusion avoided. This ICER is driven by the increased probability that these patients would require a higher level of post-operative care and additional surgeries. The results of these analyses were shown to be robust for the majority of deterministic sensitivity analyses.Conclusions: The results of the economic evaluation suggest that while routine cell salvage is a marginally more effective strategy than standard care in avoiding a donor blood transfusion there is uncertainty in relation to whether it is a less or more costly strategy. The lack of long term data on the health and quality of life of patients in both arms of the trial means that further research is needed to fully understand the cost implications of both strategies.Trial registration number: Current Controlled Trials ISRCTN66118656",
author = "Carol McLoughlin and Tracy Roberts and Louise Jackson and Philip Moore and Matthew Wilson and Richard Hooper and Shubha Allard and Ian Wrench and Lee Beresford and James Geoghegan and Daniels, {Jane P.} and Sue Catling and Clark, {Vicki A.} and Paul Ayuk and Stephen Robson and {Gao Smith}, Fang and Matthew Hogg and Doris Lanz and Julie Dodds and Khalid Khan",
year = "2019",
month = "2",
day = "9",
doi = "10.1136/bmjopen-2018-022352",
language = "English",
volume = "9",
journal = "BMJ open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "2",

}

RIS

TY - JOUR

T1 - Cost-effectiveness of cell salvage and donor blood transfusion during caesarean section

T2 - results from a randomised controlled trial

AU - McLoughlin, Carol

AU - Roberts, Tracy

AU - Jackson, Louise

AU - Moore, Philip

AU - Wilson, Matthew

AU - Hooper, Richard

AU - Allard, Shubha

AU - Wrench, Ian

AU - Beresford, Lee

AU - Geoghegan, James

AU - Daniels, Jane P.

AU - Catling, Sue

AU - Clark, Vicki A.

AU - Ayuk, Paul

AU - Robson, Stephen

AU - Gao Smith, Fang

AU - Hogg, Matthew

AU - Lanz, Doris

AU - Dodds, Julie

AU - Khan, Khalid

PY - 2019/2/9

Y1 - 2019/2/9

N2 - Objectives: To evaluate the cost-effectiveness of routine use of cell salvage during caesarean section in mothers at risk of haemorrhage compared with current standard of care.Design: Model-based cost-effectiveness evaluation alongside a multicentre randomised controlled trial (RCT). Three main analyses were carried out on the trial data: (1) based on the intention to treat principle; (2) based on the per protocol principle; (3) only participants who underwent an emergency caesarean section.Setting: 26 obstetric units in the UK.Participants: 3028 women at risk of haemorrhage recruited between June 2013 and April 2016. Interventions: Cell salvage (intervention) versus routine care without salvage (control).Primary outcome measures: Cost-effectiveness based on incremental cost per donor blood transfusion avoided.Results: In the intention to treat analysis the mean difference in total costs between cell salvage and standard care was £83. The estimated incremental cost-effectiveness ratio (ICER) was £8,110 per donor blood transfusion avoided. For the per protocol analysis the mean difference in total costs was £92 and the ICER was £8,252. In the emergency caesarean section analysis the mean difference in total costs was £55 and the ICER was £13,713 per donor blood transfusion avoided. This ICER is driven by the increased probability that these patients would require a higher level of post-operative care and additional surgeries. The results of these analyses were shown to be robust for the majority of deterministic sensitivity analyses.Conclusions: The results of the economic evaluation suggest that while routine cell salvage is a marginally more effective strategy than standard care in avoiding a donor blood transfusion there is uncertainty in relation to whether it is a less or more costly strategy. The lack of long term data on the health and quality of life of patients in both arms of the trial means that further research is needed to fully understand the cost implications of both strategies.Trial registration number: Current Controlled Trials ISRCTN66118656

AB - Objectives: To evaluate the cost-effectiveness of routine use of cell salvage during caesarean section in mothers at risk of haemorrhage compared with current standard of care.Design: Model-based cost-effectiveness evaluation alongside a multicentre randomised controlled trial (RCT). Three main analyses were carried out on the trial data: (1) based on the intention to treat principle; (2) based on the per protocol principle; (3) only participants who underwent an emergency caesarean section.Setting: 26 obstetric units in the UK.Participants: 3028 women at risk of haemorrhage recruited between June 2013 and April 2016. Interventions: Cell salvage (intervention) versus routine care without salvage (control).Primary outcome measures: Cost-effectiveness based on incremental cost per donor blood transfusion avoided.Results: In the intention to treat analysis the mean difference in total costs between cell salvage and standard care was £83. The estimated incremental cost-effectiveness ratio (ICER) was £8,110 per donor blood transfusion avoided. For the per protocol analysis the mean difference in total costs was £92 and the ICER was £8,252. In the emergency caesarean section analysis the mean difference in total costs was £55 and the ICER was £13,713 per donor blood transfusion avoided. This ICER is driven by the increased probability that these patients would require a higher level of post-operative care and additional surgeries. The results of these analyses were shown to be robust for the majority of deterministic sensitivity analyses.Conclusions: The results of the economic evaluation suggest that while routine cell salvage is a marginally more effective strategy than standard care in avoiding a donor blood transfusion there is uncertainty in relation to whether it is a less or more costly strategy. The lack of long term data on the health and quality of life of patients in both arms of the trial means that further research is needed to fully understand the cost implications of both strategies.Trial registration number: Current Controlled Trials ISRCTN66118656

U2 - 10.1136/bmjopen-2018-022352

DO - 10.1136/bmjopen-2018-022352

M3 - Article

VL - 9

JO - BMJ open

JF - BMJ open

SN - 2044-6055

IS - 2

M1 - bmjopen-2018-022352

ER -