The aim was to assess the cost-effectiveness of erythropoietin (EPO) to reduce patients' exposure to perioperative allogenic blood products in orthopaedic surgery. The use of EPO was assessed for EPO used alone and for EPO, to augment preoperative autologous donation (PAD). A decision analytical model was designed incorporating (i) the risk of receiving allogeneic blood, (ii) the costs of blood products, (iii) the likelihood of developing transfusion-related diseases, (iv) the costs of transfusion-related diseases, (v) the impact of transfusion-related diseases on patient morbidity and mortality and (vi) the effect of EPO upon the probability of transfusion. The efficacy of EPO was derived from data from a meta-analysis of published randomized trials. Estimates for the other parameters were obtained by a systematic review of the literature. EPO alone led to only modest incremental benefit compared to no intervention for orthopaedic surgery (0.000024 life-years gained per patient). As an augmentation to PAD, EPO also led to modest benefits (0.000006 life-years gained per patient). For EPO compared to no intervention, the incremental cost per life-year gained was $66 million (Canadian). For EPO to augment PAD, the incremental cost per life-year gained was $329 million (Canadian). Detailed sensitivity analysis did not reveal any circumstances in which the cost-effectiveness ratios reached a level generally considered attractive. On the basis of cost-effectiveness, the use of EPO to reduce perioperative allogeneic transfusions in orthopaedic surgery did not meet criteria conventionally considered acceptable.
The objective was to assess the impact of different levels of risk of disease on a woman's preferences for health states. Women were provided with health scenarios incorporating different levels of lifetime risks for breast cancer, hip fracture, and coronary heart disease (CHD). In this way, we were able to determine the incremental effect of changes in risks of each disease on preference values.
Preference values and utility scores were obtained for six health scenarios by both the feeling thermometer (FT) and standard gamble (SG) methods. Scenarios presented the different lifetime risks of CHD, breast cancer, and hip fracture associated with and not associated with long-term use of hormone replacement therapy (HRT) and raloxifene. Risks of breast cancer were based on perceived risks and population risks. The sample population consisted of 40 healthy female volunteers aged between 45 and 65 years randomly selected from the Ottawa-Carleton district.
Based on their perceived risk of breast cancer, the women had higher value scores for the raloxifene risk profile than for both HRT (p = .002) and no therapy (p = .003), with similar results for analyses based on population risks and from utility scores. Regression analysis showed that the risk of breast cancer (p