New CEBaP publication: Lack of proven cost-effectiveness of preoperative EPO and iron in anaemic elective surgery patients


The International Consensus Conference on Patient Blood Management, held in Frankfurt, Germany in 2018 resulted in a weak recommendation to routinely use iron preoperatively, but not erythrocyte-stimulating agents (ESAs), in elective surgery patients with anaemia. However, short-acting ESAs combined with iron supplementation were weakly recommended to be used in major orthopaedic surgery patients. These recommendations were not based on any cost-effectiveness studies.

To further substantiate this important aspect of clinical decision-making, CEBaP has conducted a systematic review of economic evaluations on the use of preoperative ESAs and/or iron in anaemic elective surgery patients. Only 5 studies were identified, one on intravenous iron supplementation and 4 on erythropoietin in combination with oral iron supplementation. From this, the cost-effectiveness of iron supplementation remains uncertain while erythropoietin in combination with iron is likely not cost-effective, with incremental cost-effectiveness ratios in the range of millions (GBP or CAD) invested per (quality-adjusted) life year gained. Future guideline updates should take into account these findings.

The full text of this work can be found here.