Biomaterial Database

Cost-effectiveness of cell salvage and donor blood transfusion during caesarean section: results from a randomised controlled trial. 2019

Carol McLoughlin, and Tracy E Roberts, and Louise J Jackson, and Philip Moore, and Matthew Wilson, and Richard Hooper, and Shubha Allard, and Ian Wrench, and Lee Beresford, and James Geoghegan, and Jane Daniels, and Sue Catling, and Vicki A Clark, and Paul Ayuk, and Stephen Robson, and Fang Gao-Smith, and Matthew Hogg, and Doris Lanz, and Julie Dodds, and Khalid S Khan, and

Health Economics Unit, University of Birmingham, Birmingham, UK.

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. Model-based cost-effectiveness evaluation alongside a multicentre randomised controlled trial. 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. 26 obstetric units in the UK. 3028 women at risk of haemorrhage recruited between June 2013 and April 2016. Cell salvage (intervention) versus routine care without salvage (control). Cost-effectiveness based on incremental cost per donor blood transfusion avoided. 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 £8110 per donor blood transfusion avoided. For the per-protocol analysis, the mean difference in total costs was £92 and the ICER was £8252. 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 postoperative care and additional surgeries. The results of these analyses were shown to be robust for the majority of deterministic sensitivity analyses. 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. ISRCTN66118656.

UI	MeSH Term	Description	Entries
D011247	Pregnancy	The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH.	Gestation,Pregnancies
D011788	Quality of Life	A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral, social environment as well as health and disease.	HRQOL,Health-Related Quality Of Life,Life Quality,Health Related Quality Of Life
D001803	Blood Transfusion	The introduction of whole blood or blood component directly into the blood stream. (Dorland, 27th ed)	Blood Transfusions,Transfusion, Blood,Transfusions, Blood
D002585	Cesarean Section	Extraction of the FETUS by means of abdominal HYSTEROTOMY.	Abdominal Delivery,Delivery, Abdominal,C-Section (OB),Caesarean Section,Postcesarean Section,Abdominal Deliveries,C Section (OB),C-Sections (OB),Caesarean Sections,Cesarean Sections,Deliveries, Abdominal
D003362	Cost-Benefit Analysis	A method of comparing the cost of a program with its expected benefits in dollars (or other currency). The benefit-to-cost ratio is a measure of total return expected per unit of money spent. This analysis generally excludes consideration of factors that are not measured ultimately in economic terms. In contrast a cost effectiveness in general compares cost with qualitative outcomes.	Cost and Benefit,Cost-Benefit Data,Benefits and Costs,Cost Benefit,Cost Benefit Analysis,Cost-Utility Analysis,Costs and Benefits,Economic Evaluation,Marginal Analysis,Analyses, Cost Benefit,Analysis, Cost Benefit,Analysis, Cost-Benefit,Analysis, Cost-Utility,Analysis, Marginal,Benefit and Cost,Cost Benefit Analyses,Cost Benefit Data,Cost Utility Analysis,Cost-Benefit Analyses,Cost-Utility Analyses,Data, Cost-Benefit,Economic Evaluations,Evaluation, Economic,Marginal Analyses
D005260	Female		Females
D006113	United Kingdom	Country in northwestern Europe including Great Britain and the northern one-sixth of the island of Ireland, located between the North Sea and north Atlantic Ocean. The capital is London.	Great Britain,Isle of Man
D006470	Hemorrhage	Bleeding or escape of blood from a vessel.	Bleeding,Hemorrhages
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D057725	Operative Blood Salvage	Recovery of blood lost from surgical procedures for reuse by the same patient in AUTOLOGOUS BLOOD TRANSFUSIONS. It is collected during (intraoperatively) or after completion of (postoperatively) the surgical procedures.	Cell Saver Technique,Intraoperative Blood Cell Salvage,Intraoperative Blood Salvage,Post-Operative Blood Salvage,Postoperative Blood Salvage,Blood Salvage, Intraoperative,Blood Salvage, Operative,Blood Salvage, Post-Operative,Blood Salvage, Postoperative,Cell Saver Techniques,Post Operative Blood Salvage,Salvage, Intraoperative Blood,Salvage, Post-Operative Blood,Salvage, Postoperative Blood,Saver Technique, Cell,Technique, Cell Saver