Cost-effectiveness of routine type and screens in select urological surgeries.
Blood grouping and crossmatching
Blood loss
Blood transfusion
Penile implants
Prostatectomy
Surgical
Urologic surgery
Journal
International urology and nephrology
ISSN: 1573-2584
Titre abrégé: Int Urol Nephrol
Pays: Netherlands
ID NLM: 0262521
Informations de publication
Date de publication:
Apr 2023
Apr 2023
Historique:
received:
05
10
2022
accepted:
20
12
2022
pubmed:
8
1
2023
medline:
24
3
2023
entrez:
7
1
2023
Statut:
ppublish
Résumé
To evaluate the cost-effectiveness of obtaining a preoperative type and screen (T/S) for common urologic procedures. A decision tree model was constructed to track surgical patients undergoing two preoperative blood ordering strategies as follows: obtaining a preoperative T/S versus not doing so. The model was applied to the National (Nationwide) Inpatient Sample (NIS) data, from January 1, 2006 to September 30, 2015. Cost estimates for the model were created from combined patient-level data with published costs of a T/S, type and crossmatch (T/C), a unit of pRBC, and one unit of emergency-release transfusion (ERT). The primary outcome was the incremental cost per ERT prevented, expressed as an incremental cost-effectiveness ratio (ICER) between the two preoperative blood ordering strategies. A cost-effectiveness analysis determined the ICER of obtaining preoperative T/S to prevent an emergency-release transfusion (ERT), with a willingness-to-pay threshold of $1,500.00. A total of 4,113,144 surgical admissions from 2006 to 2015 were reviewed. The overall transfusion rate was 10.54% (95% CI, 10.17-10.91) for all procedures. The ICER of preoperative T/S was $1500.00 per ERT prevented. One-way sensitivity analysis demonstrated that the risk of transfusion should exceed 4.12% to justify preoperative T/S. Routine preoperative T/S for radical prostatectomy (rate = 3.88%) and penile implants (rate = .91%) does not represent a cost-effective practice for these surgeries. It is important for urologists to review their institution T/S policy to reduce inefficiencies within the preoperative setting.
Identifiants
pubmed: 36609935
doi: 10.1007/s11255-022-03452-6
pii: 10.1007/s11255-022-03452-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
823-833Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Nature B.V.
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