Are lower levels of red blood cell transfusion more cost-effective than liberal levels after cardiac surgery? Findings from the TITRe2 randomised controlled trial
Objective: To assess the incremental cost and cost-effectiveness of a restrictive versus a liberal red blood cell transfusion threshold for after cardiac surgery patients. <br/> Design: A within-trial cost-effectiveness analysis with a three month time horizon, based on a multi-centre superio...
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| Format: | Journal article |
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BMJ Publishing Group
2016
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| _version_ | 1797103156041089024 |
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| author | Stokes, E Wordsworth, S Bargo, D TITRe2 Investigators |
| author_facet | Stokes, E Wordsworth, S Bargo, D TITRe2 Investigators |
| author_sort | Stokes, E |
| collection | OXFORD |
| description | Objective: To assess the incremental cost and cost-effectiveness of a restrictive versus a liberal red blood cell transfusion threshold for after cardiac surgery patients. <br/> Design: A within-trial cost-effectiveness analysis with a three month time horizon, based on a multi-centre superiority randomised controlled trial from the perspective of the National Health Service (NHS) and personal social services in the United Kingdom (UK). <br/> Setting: 17 specialist cardiac surgery centres in UK NHS hospitals. <br/> Participants: 2003 patients aged over 16 years undergoing non-emergency cardiac surgery with a post-operative haemoglobin of less than 9g/dL. <br/> Interventions: Restrictive (transfuse if haemoglobin <7.5g/dL) or liberal (transfuse if haemoglobin <9g/dL) threshold during hospitalisation after surgery. <br/> Main outcome measures: Health related quality of life measured using the EQ-5D-3L to calculate quality-adjusted life years (QALYs). <br/> 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. <br/> 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. |
| first_indexed | 2024-03-07T06:16:04Z |
| format | Journal article |
| id | oxford-uuid:f11e92a6-3632-40b1-93ee-ba53d39d30f9 |
| institution | University of Oxford |
| last_indexed | 2024-03-07T06:16:04Z |
| publishDate | 2016 |
| publisher | BMJ Publishing Group |
| record_format | dspace |
| spelling | oxford-uuid:f11e92a6-3632-40b1-93ee-ba53d39d30f92022-03-27T11:53:35ZAre lower levels of red blood cell transfusion more cost-effective than liberal levels after cardiac surgery? Findings from the TITRe2 randomised controlled trialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:f11e92a6-3632-40b1-93ee-ba53d39d30f9Symplectic Elements at OxfordBMJ Publishing Group2016Stokes, EWordsworth, SBargo, DTITRe2 InvestigatorsObjective: To assess the incremental cost and cost-effectiveness of a restrictive versus a liberal red blood cell transfusion threshold for after cardiac surgery patients. <br/> Design: A within-trial cost-effectiveness analysis with a three month time horizon, based on a multi-centre superiority randomised controlled trial from the perspective of the National Health Service (NHS) and personal social services in the United Kingdom (UK). <br/> Setting: 17 specialist cardiac surgery centres in UK NHS hospitals. <br/> Participants: 2003 patients aged over 16 years undergoing non-emergency cardiac surgery with a post-operative haemoglobin of less than 9g/dL. <br/> Interventions: Restrictive (transfuse if haemoglobin <7.5g/dL) or liberal (transfuse if haemoglobin <9g/dL) threshold during hospitalisation after surgery. <br/> Main outcome measures: Health related quality of life measured using the EQ-5D-3L to calculate quality-adjusted life years (QALYs). <br/> 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. <br/> 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. |
| spellingShingle | Stokes, E Wordsworth, S Bargo, D TITRe2 Investigators Are lower levels of red blood cell transfusion more cost-effective than liberal levels after cardiac surgery? Findings from the TITRe2 randomised controlled trial |
| title | Are lower levels of red blood cell transfusion more cost-effective than liberal levels after cardiac surgery? Findings from the TITRe2 randomised controlled trial |
| title_full | Are lower levels of red blood cell transfusion more cost-effective than liberal levels after cardiac surgery? Findings from the TITRe2 randomised controlled trial |
| title_fullStr | Are lower levels of red blood cell transfusion more cost-effective than liberal levels after cardiac surgery? Findings from the TITRe2 randomised controlled trial |
| title_full_unstemmed | Are lower levels of red blood cell transfusion more cost-effective than liberal levels after cardiac surgery? Findings from the TITRe2 randomised controlled trial |
| title_short | Are lower levels of red blood cell transfusion more cost-effective than liberal levels after cardiac surgery? Findings from the TITRe2 randomised controlled trial |
| title_sort | are lower levels of red blood cell transfusion more cost effective than liberal levels after cardiac surgery findings from the titre2 randomised controlled trial |
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