OBJECTIVES: Transfusion of allogeneic blood still is common in orthopedic surgery albeit associated with higher morbidity and mortality. This analysis evaluates from the perspective of a German hospital the potential cost savings of Epoetin alfa compared to predonated autologous blood transfusions or to no-blood-conservation-strategy during elective hip and knee replacement surgery by reducing allogeneic blood transfusions and their associated infectious adverse events.  METHODS: Individual patients (n = 10,000) were created based on data from controlled trials, the German DRG institute (InEK) and various publications and entered into a stochastic model (Monte-Carlo) one of three treatment arms: Epoetin alfa, preoperative autologous donation and no-blood-conservation-strategy. The model is focused on the costs and events of the procedure and follow-up. The model was validated by an independent external consultant. Clinical and economical variables were obtained from clinical trial databases, the German DRG System, patient records and medical publications- in particular cost per transfusion (allogeneic red blood cells: € 320/unit and autologous red blood cells: € 280/unit), pneumonia treatment (€ 5,000), and length of stay (€ 300/day). Probabilistic sensitivity analyses were performed to determine which, if any, factors had an influence on the model's clinical and cost outcomes.  RESULTS: At acquisition costs of € 375/40,000 IE Epoetin alfa is cost saving compared to autologous blood donation, and at € 185/40,000 IE compared to no-blood-conservation-strategy. The results were most sensitive to the cost of Epoetin alfa, blood units and hospital days. CONCLUSIONS: Upcoming shortages and increasing prices of red blood cells will make Epoetin alfa an attractive blood conservation strategy for anemic patients at reasonable costs, due the reduction in allogeneic blood transfusions and their associated infectious adverse events.