Cost-Effectiveness of Alternatives to Allogeneic Blood Transfusion; Reviewing the Available Evidence

Abstract

Major progress has been made during the last decade in the safety of allogeneic blood products. Donor deferral and extended testing for viruses and bacteria substantially reduced risks associated with blood transfusion. The window period of detection is almost closed and any remaining pathogen might in future be eliminated by pathogen inactivation. However, the small risk of complications after blood transfusion still remains a major concern to the general public and health policy makers The perception of these risks and potential judicial consequences cause decision makers to favour implementation of procedures to further improve blood transfusion safety [1]. Besides improving safety of allogeinic blood products itself, risk reduction can be achieved by limiting the number of allogeinic transfusions transfused to the recipient. These conservation strategies comprise autologous transfusion, acute normovolemic hemodilution, use of blood growth factors (erythropoietin), peri-operative cell salvage, artificial blood and development of guidelines for minimal use of blood transfusion [2–4] The utilisation of conservation technologies varies between and within countries [5]. From a pharmaco-economic point of view it is relevant to investigate whether monetary benefits of averted transfusion complications by conservation techniques surpass the costs, or, whether the marginal net costs justify the health gains achieved.