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  • Poster presentation
  • Open Access

A cost-effectiveness analysis of erthropoietin in ICU patients

  • 1,
  • 1 and
  • 1
Critical Care20048 (Suppl 1) :P128

https://doi.org/10.1186/cc2595

  • Published:

Keywords

  • Erythropoietin
  • Standard Care
  • Dominant Strategy
  • Recombinant Human Erythropoietin
  • Lower Infection Rate

Introduction

Recombinant human erythropoietin (rhEPO) has been shown to decrease the packed red blood cell (PRBC) transfusion requirement by about 20% among ICU patients admitted for longer than 48 hours. Despite this, its use has not been widely instituted, in part due to its cost.

Methods

A decision analytic Markov process was designed to model anemia management strategies for patients admitted to the ICU for > 48 hours. The model compared two strategies: standard care versus standard care plus administration of rhEPO, 40,000 U weekly. Probabilities, costs and outcomes were derived from longitudinal studies of ICU patients, current Canadian medical costs and a randomized trial of rhEPO versus placebo for ICU patients. The model measured ICU costs arising from administration of PRBC and rhEPO, long-term costs of infection and effectiveness in reducing infection. The base-case data included: rhEPO cost $439/40,000 U, PRBC cost $616/U, median ICU length of stay 4 days, overall probability of PRBC transfusion 0.6 per patient per admission and mean number PRBCs transfused 3 U per patient. Long-term costs of infection (hepatitis C or HIV) were estimated at $200,000 per infection. All costs are expressed in US dollars.

Results

The mean cost per patient using the rhEPO strategy was $1030 vs $1323 for no rhEPO. Fewer units of PRBCs were administered in the rhEPO arm, resulting in a lower infection rate. rhEPO use was therefore both less expensive and more effective (i.e. it was the dominant strategy). One-way sensitivity analyses revealed that administration of rhEPO remained the preferred strategy provided that the PRBC cost was greater than $186/U or that the rhEPO cost was less than $1455/40,000 U. These results can be generalized: provided that the cost of rhEPO < 2.4 × cost 1 U PRBC, the rhEPO strategy will be preferable. Further, the advantage of treatment with rhEPO was maintained down to an expected transfusion rate of 1.1 U PRBC per patient per admission. Decreasing the probability of infection or increasing the long-term cost of infection did not significantly affect the model.

Conclusion

The management of chronic anemia among ICU patients admitted > 48 hours using rhEPO appears to be cost-effective, provided that the rhEPO cost is less than 2.4 times the cost of 1 U PRBC. This effect is retained at low expected transfusion rates and with changes in the cost or risk of infection arising from blood administration.

Authors’ Affiliations

(1)
Sunnybrook and Women's College Health Sciences Center, Toronto, Canada

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