Cost-Effective Analysis of ANH Versus PAD

Since there is no good evidence that either PAD or ANH is effective at eliminating allogeneic blood transfusions, autologous blood collection techniques cannot be

TABLE 48-6 -- Criteria for selection of patients for acute normovolemic hemodilution

1. Likelihood of transfusion exceeds 10% (i.e., blood requested for crossmatch according to a maximum surgical blood order schedule)

2. Preoperative hemoglobin level of at least 12 g/dL

3. Absence of clinically significant coronary, pulmonary, renal, or liver disease

4. Absence of severe hypertension

5. Absence of infection and risk of bacteremia

considered cost-effective alternatives to the use of allogeneic blood. The majority of the trials evaluating the efficacy of ANH compare this blood conservation technique to PAD because autologous blood donation is considered to be a "standard of care" for many elective surgical procedures in the United States and many patients request its use. Medicolegal concerns may also prevent the inclusion of a treatment arm consisting of only allogeneic blood transfusion because blood safety acts in several states mandate that physicians discuss autologous blood options prior to elective surgical procedures.^[5] A review of the literature revealed seven studies that compare the cost-effectiveness of ANH versus PAD for elective surgery.^[71]

All of these studies found ANH to be equivalent to PAD in eliminating the need for allogeneic blood transfusions and suggest that ANH and PAD are equivalent for avoiding allogeneic blood transfusions during elective surgery. Long-term outcomes including anesthesia and surgery times, intraoperative hemodynamic values, and length of hospital stays were also equivalent in PAD and ANH.

Because ANH and PAD appear to have equivalent efficacy, it is not possible to do a cost-effectiveness evaluation comparing these autologous transfusion modalities. However, if two interventions have equivalent outcomes but different costs, medical economists often perform a cost minimization analysis to determine the least-cost alternative.^[72] Despite the fact that only a few studies include economic evaluations comparing the cost of autologous blood techniques, all of these studies demonstrate that ANH is much less costly than PAD.^[71] ANH can, therefore, be considered a cost-minimizing technique for procuring autologous blood prior to elective surgery.