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Cost-Effectiveness Analysis of Intraoperative Cell Salvage for Cesarean Delivery
Abstract Number: T-06
Abstract Type: Original Research
Background: Cell salvage for obstetric hemorrhage is effective in attenuating allogeneic blood product consumption, but uncertainty exists around optimal cost-effective strategies by which to implement cell salvage in obstetrics. Our objective was to determine the cost-effectiveness of cell salvage strategies in cesarean delivery using a societal perspective and lifetime horizon.
Methods: We used a Markov decision analysis model to compare the cost-effectiveness of three primary strategies: use of cell salvage for every cesarean delivery; cell salvage use for high-risk cases alone; and no cell salvage. We assumed a societal perspective and a lifetime horizon for the base case of a 26-year-old nulliparous woman presenting for cesarean delivery. For each strategy, the model integrated: 1) probabilities of hemorrhage, hysterectomy, transfusion reactions, emergency procedures, and cell salvage utilization; 2) utilities for quality of life (0=dead, 1=perfect health); and 3) costs at the societal level. One- and two-way sensitivity analyses as well as Monte Carlo probabilistic sensitivity analysis were performed. A threshold of $100,000 per quality-adjusted life-year (QALY) gained was utilized as a cost-effectiveness criterion.
Results: Cell salvage use for cases at high risk for hemorrhage (IOCS-HR) was cost-effective, with an incremental cost-effectiveness ratio (ICER) of $34,881 per QALY gained. Routine cell salvage use for all cesarean deliveries was not cost-effective, costing $415,488 per QALY gained. The utility of the health state associated with receiving any transfusion at which IOCS-HR exceeds the $100,000 per QALY threshold was 0.902 or greater (base case 0.8). Results were not sensitive to individual variation of other model parameters. The probabilistic sensitivity analysis showed that at the $100,000 per QALY gained threshold, there is >85% likelihood that IOCS-HR is favorable.
Conclusions: The use of cell salvage for cases at high risk for hemorrhage is economically reasonable; routine cell salvage use for all cesarean deliveries is not. Further investigations aimed at elucidating the utility of the health state associated with allogeneic transfusion in obstetric patients will be useful in further assessing the robustness of these findings.
Albright CM. Obstet Gynec. 2014;124:690-6.
Milne ME. Obstet Gynec. 2015;125:919-23.