Are lower levels of red blood cell transfusion more cost-effective than liberal levels after cardiac surgery? Findings from the TITRe2 randomised controlled trial. Issue 8 (1st August 2016)

• Record Type: Journal Article
• Authors: Stokes, E A; Wordsworth, S; Bargo, D; Pike, K; Rogers, C A; Brierley, R C M; Angelini, G D; Murphy, G J; Reeves, B C
• Other Names: author non-byline.; Tang Augustine author non-byline.; Saravanan Palaniappan author non-byline.; Kong Robert author non-byline.; Skipper Nicola author non-byline.; Hopkins Emma author non-byline.; Lambert Penny author non-byline.; Bhudia Sunil K author non-byline.; Gocher Denise author non-byline.; Bennett Sean author non-byline.; Smith Neil author non-byline.; Walker Adam author non-byline.; Bennett Mark author non-byline.; Dalrymple-Hay Malcolm author non-byline.; Pearse Maxine author non-byline.; Ritchie Andrew J author non-byline.; Redman Emily author non-byline.; Solesbury Amanda author non-byline.; Zamvar Vipin author non-byline.; Lockwood Geoffrey author non-byline.; Fiorentino Francesca author non-byline.; Rahman Alima author non-byline.; Kunst Gudrun author non-byline.; Parsons Georgina author non-byline.; Wade-Smith Fiona author non-byline.; Cross Michael H author non-byline.; Elliot Stuart author non-byline.; Beardow Zoe author non-byline.; Sypt Tom author non-byline.; Williams Martina author non-byline.; Fabri Brian author non-byline.; Kemp Ian author non-byline.; Young Andrea author non-byline.; Stratford Nick author non-byline.; Robinson Heather author non-byline.; Clark Stephen author non-byline.; Rowling Sarah author non-byline.; Forsyth Hazel author non-byline.; Gill Ravi author non-byline.; Wadhams Beverley author non-byline.; de Courcy-Golder Kim author non-byline.; Morgan Ian author non-byline.; Greatbach Emma author non-byline.; Ng Alex author non-byline.;
• Is Part Of: BMJ open. Volume 6:Issue 8(2016)
• Publication Date: 2016-08-01
• Subjects: blood transfusion -- cost-effectiveness; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2016-011311
• Languages: English
• ISSNs: 2044-6055

Abstract

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. Trial registration number: ISRCTN70923932; Results.