Are lower levels of red blood cell transfusion more cost-effective than liberal levels after cardiac surgery? Findings from the TITRe2 randomised controlled trial

Stokes, Elizabeth, Wordsworth, Sarah, Bargo, Danielle, Pike, Katie, Rogers, Chris, Brierley, Rachel, Angelini, Gianni, Murphy, Gavin and Reeves, Barnaby (2016) Are lower levels of red blood cell transfusion more cost-effective than liberal levels after cardiac surgery? Findings from the TITRe2 randomised controlled trial. BMJ Open, 6 (8). e011311. ISSN 2044-6055

[img]
Preview
Text
e011311.full.pdf - Published Version
Available under License Creative Commons Attribution 4.0.

Download (969kB) | Preview
Official URL: https://doi.org/10.1136/bmjopen-2016-011311

Abstract

Objective - To assess the incremental cost and cost-effectiveness of a restrictive versus a liberal red blood cell transfusion threshold after cardiac surgery.

Design - A within-trial cost-effectiveness analysis with a 3-month time horizon, based on a multicentre superiority randomised controlled trial from the perspective of the National Health Service (NHS) and personal social services in the UK.

Setting - 17 specialist cardiac surgery centres in UK NHS hospitals.

Participants - 2003 patients aged >16 years undergoing non-emergency cardiac surgery with a postoperative haemoglobin of <9 g/dL.

Interventions - Restrictive (transfuse if haemoglobin <7.5 g/dL) or liberal (transfuse if haemoglobin <9 g/dL) threshold during hospitalisation after surgery.

Main outcome measures - Health-related quality of life measured using the EQ-5D-3L to calculate quality-adjusted life years (QALYs).

Results - The total costs from surgery up to 3 months were £17 945 and £18 127 in the restrictive and liberal groups (mean difference is −£182, 95% CI −£1108 to £744). The cost difference was largely attributable to the difference in the cost of red blood cells. Mean QALYs to 3 months were 0.18 in both groups (restrictive minus liberal difference is 0.0004, 95% CI −0.0037 to 0.0045). The point estimate for the base-case cost-effectiveness analysis suggested that the restrictive group was slightly more effective and slightly less costly than the liberal group and, therefore, cost-effective. However, there is great uncertainty around these results partly due to the negligible differences in QALYs gained.

Conclusions - We conclude that there is no clear difference in the cost-effectiveness of restrictive and liberal thresholds for red blood cell transfusion after cardiac surgery.

Item Type: Article
Additional Information: This article was written on behalf of the TITRe2 Investigators group of which Stephen Clark is a member.
Subjects: B100 Anatomy, Physiology and Pathology
Department: Faculties > Health and Life Sciences > Applied Sciences
Depositing User: Becky Skoyles
Date Deposited: 30 Nov 2017 09:51
Last Modified: 21 May 2018 18:45
URI: http://nrl.northumbria.ac.uk/id/eprint/32698

Actions (login required)

View Item View Item

Downloads

Downloads per month over past year

View more statistics


Policies: NRL Policies | NRL University Deposit Policy | NRL Deposit Licence