Economic evaluation of restrictive vs. liberal transfusion strategy following acute myocardial infarction (REALITY): trial-based cost–effectiveness and cost–utility analyses
Authors' 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 At 1 year, the restrictive strategy remained cost-saving, but clinical non-inferiority on MACE was no longer maintained.
Study context
- Population
- Acute myocardial infarction (AMI) patients with anaemia (haemoglobin between 7–8 and 10 g/dL)648 per-protocol analysed
- Participants
- 666 patients
- Comparison
- Restrictive vs liberal transfusion strategy
- Restrictiven = 342
- Liberaln = 324reference
- Primary endpoint
- Cost-effectiveness (MACE averted as effectiveness outcome) and cost-utility ratio
- Follow-up
- 30 days and 1 year
Methodological detailstrial-based, multicentre (35 hospitals, France and Spain), per-protocol population, 1-year prospective collection of resource utilization and quality of life (EQ5D3L)
- Trial-based
- Multicentre (35 hospitals, France and Spain)
- Per-protocol population
- 1-year prospective collection of resource utilization and quality of life (EQ5D3L)
Primary result
As reported in the abstract
Incremental cost-effectiveness ratio (MACE averted) · 30 days
ICER, restrictive vs liberal: € saved per additional MACE averted
€33 065
Probability restrictive strategy cost-saving and MACE-reducing (dominant)
84%
Further findings
Cost-utility ratio · 1 year
- Point estimate: € saved per QALY gained
- €191 500
Cost-effectiveness (cumulated MACE) · 1 year
- Decremental cost-effectiveness ratio, point estimate: € saved per additional MACE with restrictive strategy
- €72 000
- Cumulated MACE outside the pre-specified non-inferiority margin
Original publication
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. Published 24 May 2022. doi:10.
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