Cost-effectiveness of recombinant human erythropoietin for reducing red blood cells transfusions in critically ill patients

Objective: To examine the cost-effectiveness of using recombinant human erythropoietin (rHuEPO) to reduce red blood cells (RBC) transfusions in intensive care unit (ICU) patients. Methods: Decision analysis examining costs and effectiveness of using rHuEPO versus not using rHuEPO in a simulated adult medical/surgical/trauma (mixed) ICU. Two independent cost-effectiveness models were created based on the results of two multicenter studies that investigated the use of rHuEPO. Base case assumptions and estimates of effectiveness were obtained from these two studies. Mean cumulative doses of rHuEPO were 190,900 units and 102,400 units for studies 1 and 2, respectively. The models accounted for the deferral rate for allogeneic RBC transfusions, rHuEPO efficacy (the reduction in allogeneic RBC use), and adverse effects of rHuEPO and allogeneic RBC transfusions. Model estimates were obtained from published sources. Costs were expressed in 2002 US dollar ($) and effectiveness was measured using discounted quality-adjusted life-years (QALYs). A 3% discount rate was used. Probabilistic sensitivity analysis was conducted using second-order Monte Carlo simulation. Results: Incremental costs of using rHuEPO to reduce RBC transfusions amounted to $1918 and $1439; incremental effectiveness values were 0.0563 QALYs and 0.0305 QALYs; and the cost-effectiveness ratios were $34,088 and $47,149 per QALY for studies 1 and 2, respectively. The model was most sensitive to the attributable risk of nosocomial bacterial infections per RBC unit. rHuEPO was cost-effective in 52.0% of the Monte Carlo simulations for a willingness to pay of $50,000/QALY. Conclusion: rHuEPO appears to be cost-effective for reducing RBC transfusions in heterogeneous ICU populations, assuming RBC transfusions increase the risk of nosocomial bacterial infections.