OBJECTIVES

: In patients undergoing complex cardiac surgery, periprocedural significant bleeding is amongst the most alarming complications. Transfusion of allogeneic red blood cells may be necessary in at least half of the procedures with cardiopulmonary bypass (CPB), this, in turn, is associated with increased morbidity, mortality, and costs. This study assessed the cost-effectiveness of viscoelastic point-of-care testing (VE POC) vs standard laboratory tests (SLTs) for guiding transfusion therapy in Brazilian patients who underwent complex cardiac surgery in terms of quality adjusted life years (QALY).

METHODS

: We designed a decision tree from the perspective of the Brazilian public health system (Unified Health System -SUS-). We calculated the incremental cost-effectiveness ratio (ICER) under a 12-month time horizon; short (1 month) and long (11 months) term complications for each guiding transfusion therapy were considered. An alternative was considered cost-effective if the ICER was equivalent or below the value of three gross domestic product per capita for Brazil (United States dollar -USD $26,151) per QALY gained. Direct medical costs were obtained from the SUS and standardized to 2020 US dollars. Evidence of adverse events was collected from randomized clinical trials and published cohort studies. Probabilistic sensitivity analysis was conducted using Monte Carlo simulations. The model was developed using TreeAge Pro software^TM.

RESULTS

: VE POC is more effective in terms of QALYs (0.052), albeit it is more expensive (USD $84) than SLTs. The ICER of VE POC in comparison with SLTs is USD $1,628. Therefore, VE POC is projected to be cost-effective compared to SLTs.

CONCLUSIONS

: To date, this is the first study carried out in Brazil that compares the cost-effectiveness of VE POC against SLT in patients who underwent complex cardiac surgery. Our findings suggest that the Brazilian public health system may include VE POC as part of the management of complex cardiac surgeries.