Newly Published
Perioperative Medicine  |   December 2017
Cost-effectiveness Analysis of Intraoperative Cell Salvage for Obstetric Hemorrhage
Author Notes
  • From the Department of Anesthesiology (G.L., V.M., J.H.W.) and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Magee–Womens Research Institute and Foundation (F.L.F.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and the Department of Medicine and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania (K.J.S.).
  • Submitted for publication February 24, 2017. Accepted for publication October 17, 2017.
    Submitted for publication February 24, 2017. Accepted for publication October 17, 2017.×
  • Research Support: Supported by the Department of Anesthesiology and the Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Lim is supported by National Institutes of Health Building Interdisciplinary Research Careers in Women’s Health Award K12HD043441 (to Yoel Sadovsky, M.D.) and by a National Institutes of Health Ruth Kirschstein National Service Award T32MG075770 (to Yan Xu, Ph.D.). Dr. Facco is supported by National Heart, Lung, and Blood Institute Award R01HL120354.
    Research Support: Supported by the Department of Anesthesiology and the Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Lim is supported by National Institutes of Health Building Interdisciplinary Research Careers in Women’s Health Award K12HD043441 (to Yoel Sadovsky, M.D.) and by a National Institutes of Health Ruth Kirschstein National Service Award T32MG075770 (to Yan Xu, Ph.D.). Dr. Facco is supported by National Heart, Lung, and Blood Institute Award R01HL120354.×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Lim: Magee–Womens Hospital of University of Pittsburgh Medical Center, 300 Halket Street, Suite 3510, Pittsburgh, Pennsylvania 15213. limkg2@upmc.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Cardiovascular Anesthesia / Obstetric Anesthesia / Technology / Equipment / Monitoring
Perioperative Medicine   |   December 2017
Cost-effectiveness Analysis of Intraoperative Cell Salvage for Obstetric Hemorrhage
Anesthesiology Newly Published on December 7, 2017. doi:10.1097/ALN.0000000000001981
Anesthesiology Newly Published on December 7, 2017. doi:10.1097/ALN.0000000000001981
Abstract

Background: Cost-effectiveness analyses on cell salvage for cesarean delivery to inform national and societal guidelines on obstetric blood management are lacking. This study examined the cost-effectiveness of cell salvage strategies in obstetric hemorrhage from a societal perspective.

Methods: Markov decision analysis modeling compared the cost-effectiveness of three strategies: use of cell salvage for every cesarean delivery, cell salvage use for high-risk cases, and no cell salvage. A societal perspective and lifetime horizon was assumed for the base case of a 26-yr-old primiparous woman presenting for cesarean delivery. Each strategy integrated probabilities of hemorrhage, hysterectomy, transfusion reactions, emergency procedures, and cell salvage utilization; utilities for quality of life; and costs at the societal level. One-way and Monte Carlo probabilistic sensitivity analyses were performed. A threshold of $100,000 per quality-adjusted life-year gained was used as a cost-effectiveness criterion.

Results: Cell salvage use for cases at high risk for hemorrhage was cost-effective (incremental cost-effectiveness ratio, $34,881 per quality-adjusted life-year gained). Routine cell salvage use for all cesarean deliveries was not cost-effective, costing $415,488 per quality-adjusted life-year gained. Results were not sensitive to individual variation of other model parameters. The probabilistic sensitivity analysis showed that at the $100,000 per quality-adjusted life-year gained threshold, there is more than 85% likelihood that cell salvage use for cases at high risk for hemorrhage is favorable.

Conclusions: : The use of cell salvage for cases at high risk for obstetric hemorrhage is economically reasonable; routine cell salvage use for all cesarean deliveries is not. These findings can inform the development of public policies such as guidelines on management of obstetric hemorrhage.