Cost‐effectiveness analysis of preoperative transfusion in patients with sickle cell disease using evidence from the TAPS trial |
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Authors: | Eldon Spackman Mark Sculpher Jo Howard Moira Malfroy Charlotte Llewelyn Louise Choo Renate Hodge Tony Johnson David C. Rees Karin Fijnvandraat Melanie Kirby‐Allen Sally Davies Lorna Williamson |
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Affiliation: | 1. Centre for Health Economics, University of York, , York, UK;2. Department of Haematology, Guy's and St Thomas' Hospital, , London, UK;3. NHS Blood and Transplant, , London, UK;4. MRC Clinical Trials Unit, , London, UK;5. Department of Paediatric Haematology, King's College Hospital, , London, UK;6. Department of Paediatric Haematology, Academic Medical Centre, , Amsterdam, Netherlands;7. Division of Haematology/Oncology, Hospital for Sick Kids, , Toronto, ON, Canada;8. Department of Health, , London, UK |
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Abstract: | The study's objective was to assess the cost‐effectiveness of preoperative transfusion compared with no preoperative transfusion in patients with sickle cell disease undergoing low‐ or medium‐risk surgery. Seventy patients with sickle cell disease (HbSS/Sß0thal genotypes) undergoing elective surgery participated in a multicentre randomised trial, Transfusion Alternatives Preoperatively in Sickle Cell Disease (TAPS). Here, a cost‐effectiveness analysis based on evidence from that trial is presented. A decision‐analytic model is used to incorporate long‐term consequences of transfusions and acute chest syndrome. Costs and health benefits, expressed as quality‐adjusted life years (QALYs), are reported from the ‘within‐trial’ analysis and for the decision‐analytic model. The probability of cost‐effectiveness for each form of management is calculated taking into account the small sample size and other sources of uncertainty. In the range of scenarios considered in the analysis, preoperative transfusion was more effective, with the mean improvement in QALYs ranging from 0.018 to 0.206 per patient, and also less costly in all but one scenario, with the mean cost difference ranging from ?£813 to £26. All scenarios suggested preoperative transfusion had a probability of cost‐effectiveness >0.79 at a cost‐effectiveness threshold of £20 000 per QALY. |
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Keywords: | cost quality‐adjusted life years cost‐effectiveness Transfusion Alternatives Preoperatively in Sickle Cell Disease trial transfusion sickle cell disease |
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