A blood transfusion is one of the most common hospital procedures, yet there is a lack of reliable information on the costs of administering blood. This thesis aims to fill this information gap, and considers the impact on total costs of alternative transfusion management strategies in the National Health Service (NHS) in the United Kingdom. A high user of blood transfusion, cardiac surgery, acts as a clinical exemplar. Comprehensive estimates of the costs of administering blood are first produced. The costs of administering blood add substantially to the costs of the blood products themselves, costs for red blood cells are 40% higher when the costs of administration are added to red blood cell costs. These cost estimates were used to more accurately cost blood products transfused (compared to the costs of blood products only) in two economic evaluations assessing firstly, the cost-effectiveness of a restrictive versus a liberal red blood cell transfusion threshold after cardiac surgery, and secondly, the cost-effectiveness of introducing bedside tests of haemostatic function in cardiac surgery. Both economic evaluations showed little difference in costs or outcomes between the groups and uncertainty around the cost-effectiveness results. While a restrictive threshold reduces costs associated with transfusion compared to a liberal threshold, there is no evidence based on detailed and comprehensive costings, to suggest that a restrictive threshold saves the NHS money overall. Reliable resource use data are vital for economic evaluations, and a subgroup of patients in both economic evaluations enabled resource use data collected from alternative sources to be compared. There was strong agreement between primary (clinical trial) data and routine datasets for data available from both sources, however, primary data captured post-operative complications more comprehensively than routine datasets. This thesis provides hospital managers and health economists with accurate information on the costs of administering blood for budget impact assessments and economic evaluations.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:730489 |
| Date | January 2016 |
| Creators | Stokes, Elizabeth |
| Contributors | Stanworth, Simon ; Wordsworth, Sarah |
| Publisher | University of Oxford |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | https://ora.ox.ac.uk/objects/uuid:2ff34c79-7f38-4fa3-bdd1-ad0c002af439 |
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