Economic evaluation of restrictive vs. liberal transfusion strategy following acute myocardial infarction (REALITY): trial-based cost-effectiveness and cost-utility analyses.
Eur Heart J Qual Care Clin Outcomes
; 9(2): 194-202, 2023 02 28.
Article
in En
| MEDLINE
| ID: mdl-35612990
ABSTRACT
AIMS:
To estimate the cost-effectiveness and cost-utility ratios of a restrictive vs. liberal transfusion strategy in acute myocardial infarction (AMI) patients with anaemia. METHODS ANDRESULTS:
Patients (n = 666) with AMI and haemoglobin between 7-8 and 10 g/dL recruited in 35 hospitals in France and Spain were randomly assigned to a restrictive (n = 342) or a liberal (n = 324) transfusion strategy with 1-year prospective collection of resource utilization and quality of life using the EQ5D3L questionnaire. The economic evaluation was based on 648 patients from the per-protocol population. The outcomes were 30-day and 1-year cost-effectiveness, with major adverse cardiovascular events (MACEs) averted as the effectiveness outcome. and a 1-year cost-utility ratio.The 30-day incremental cost-effectiveness ratio was 33 065 saved per additional MACE averted with the restrictive vs. liberal strategy, with an 84% probability for the restrictive strategy to be cost-saving and MACE-reducing (i.e. dominant). At 1 year, the point estimate of the cost-utility ratio was 191 500 saved per quality-adjusted life year gained; however, the cumulated MACE was outside the pre-specified non-inferiority margin, resulting in a decremental cost-effectiveness ratio with a point estimate of 72 000 saved per additional MACE with the restrictive strategy.CONCLUSION:
In patients with AMI and anaemia, the restrictive transfusion strategy was dominant (cost-saving and outcome-improving) at 30 days. At 1 year, the restrictive strategy remained cost-saving, but clinical non-inferiority on MACE was no longer maintained. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02648113. ONE SENTENCESUMMARY:
The use of a restrictive transfusion strategy in patients with acute myocardial infarction is associated with lower healthcare costs, but more evidence is needed to ascertain its long-term clinical impact.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Anemia
/
Myocardial Infarction
Type of study:
Guideline
/
Health_economic_evaluation
Aspects:
Patient_preference
Limits:
Humans
Language:
En
Journal:
Eur Heart J Qual Care Clin Outcomes
Year:
2023
Document type:
Article
Affiliation country:
France