Cost-effectiveness of red blood cell transfusion vs. non-intervention in women with acute anaemia after postpartum haemorrhage

B. W. Prick, J. J. Duvekot, P. E. van der Moer, N. van Gemund, P. C M van der Salm, A. J G Jansen, D. J. van Rhenen, B. W. Mol, C. A. Uyl-de Groot

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)

Abstract

Background: Red blood cell (RBC) transfusion is frequently used to treat women with acute anaemia after postpartum haemorrhage. We aimed to assess the economic consequences of red blood cell transfusion compared to non-intervention in these women. Methods: A trial-based cost-effectiveness analysis was performed alongside the Well-Being of Obstetric patients on Minimal Blood transfusions (WOMB) trial. Women with acute anaemia [Hb 4·8-7·9 g/dl (3·0-4·9 mm)] after postpartum haemorrhage, without severe anaemic symptoms, were randomly allocated to RBC transfusion or non-intervention. Primary outcome of the trial was physical fatigue (Multidimensional Fatigue Inventory, scale 4-20; 20 represents maximal fatigue). Total costs per arm were calculated using a hospital perspective with a 6 weeks time horizon. Results: Per woman, mean costs in the RBC transfusion arm (n = 258) were €1957 compared to €1708 in the non-intervention arm (n = 261; P = 0·024). The 13% difference in costs between study arms predominantly originated from costs of RBC units, as costs of RBC units were six times higher in the RBC transfusion arm. RBC transfusion led to a small improvement in physical fatigue of 0·58 points per day; thus, the costs to improve the physical fatigue score with one point would be €431. Conclusion: In women with acute anaemia after postpartum haemorrhage (PPH), RBC transfusion is on average €249 more expensive per woman than non-intervention, with only a small gain in HRQoL after RBC transfusion. Taking both clinical and economic consequences into account, implementation of a non-intervention policy seems justified.

Original languageEnglish
Pages (from-to)381-388
Number of pages8
JournalVox Sanguinis
Volume107
Issue number4
DOIs
Publication statusPublished or Issued - 1 Nov 2014
Externally publishedYes

Keywords

  • Anaemia
  • Cost-effectiveness
  • Obstetric complication
  • Postpartum haemorrhage
  • Transfusion

ASJC Scopus subject areas

  • Hematology

Cite this