Autologous Transfusion - a Reasonable Measure under the Principles of Health Economics?

Introduction

Concern about the infectious complications of allogeneic blood transfusion, particularly HIV, have led to increased use of autologous transfusion. However, highly accurate tests for diagnosing blood borne infections, particularly HIV-1 and -2 and Hepatitis C, have been introduced into routine use. Donors at high risk for these infections have been excluded from the donor pool. As a result, the risk of blood borne infections has been reduced dramatically [1] [2].

The economic value of autologous transfusion has been extensively debated in the literature. The major determinants of the cost-effectiveness of autologous transfusion are the risk of transfusion-associated viral infections, the risk of transfusion reactions, the relative costs of procuring autologous versus allogeneic blood and the amount of unused blood since autologous units usually are discarded if not used. Another consideration is the reported increase in the risk of bacterial infections in patients receiving allogeneic blood transfusions. While the existence of this risk remains controversial, it is not universally accepted and there is increasing discussion about it in the transfusion literature.

Several authors have employed decision analyses to examine the cost-effectiveness of autologous transfusion in elective surgery [3] [4]. Of these, only one [3] explicitly considered a possible increase in bacterial infection after allogeneic transfusion. The analysis by Etchason et al.[4] nearly ended the debate in the United States by presenting results showing that autologous transfusion was very expensive. However, this paper had little impact on practice. Autologous transfusion remains a common practice for elective surgery. We performed this analysis in order to update our previous analysis to take into account new data, to update the economic basis to Year 2000 dollars and to incorporate a newer model of HIV that reflects contemporary treatment and prognosis.

Literatur

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• 2 Schreiber G B, Busch M P, Kleinman S H, Korelitz J J. The risk of transfusion-transmitted viral infections. The Retrovirus Epidemiology Donor Study.  N Engl J Med. 1996;  334 (26) 685-1690
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• 9 Carson J L, Altman D G, Duff A, Noveck H, Weinstein M P, Sonnenberg F A. et al . Risk of bacterial infection associated with allogeneic blood transfusion among patients undergoing hip fracture repair.  Transfusion. 1999;  39 (7) 694-700
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