ECONOMIC EVALUATION OF DISINVESTMENT IN HYDROXYETHYL STARCHES FOR CARDIAC SURGERY
Method: We conducted a model-based cost-consequence analysis of the clinical and economic impact of disinvestment in HES, from the hospital perspective. We incorporated probabilities of clinical events from a previously conducted meta-analysis of RCTs, including transfusion, acute kidney injury, renal replacement therapy and mortality. We incorporated hospitalization costs and the cost of adverse events from Ontario hospital discharge abstract data. Unit costs of each therapy (HES, crystalloids) were obtained from hospital records. We ran 10,000 simulations in probabilistic sensitivity analysis, to estimate the probability that HES disinvestment would save costs. We used the simulation results to estimate the value of information. We multiplied the probability that disinvestment in HES is the wrong decision, by the magnitude of expected losses and the number of cardiac surgeries over a one-year time frame. All costs were expressed in 2014 Canadian Dollars.
Result: The decision model forecasted that HES disinvestment would save costs with a median cost differenece of -$107.05 95%CrI (-$1289.81, $101.44). The probability that disinvestment in HES would increase rather than save costs was 21.2%, with an expected loss of $62.84 per hospitalization. Thus, the resulting VOI was $13.32 per patient, or $17,319.35.
Conclusion: Our decision model forecasted that disinvestment in HES would save money. Given the lack of evidence indicating HES is safer than crystalloids and the high cost of research relative to the VOI, LHSC opted to disinvest in HES.