Evidence map›Paper›PMID 30782867›Full record

Trial reportBMJ open2019

Cost-effectiveness of cell salvage and donor blood transfusion during caesarean section: results from a randomised controlled trial.

Carol McLoughlin, Tracy E Roberts, Louise J Jackson, Philip Moore, Matthew Wilson, Richard Hooper, Shubha Allard, Ian Wrench, Lee Beresford, James Geoghegan and 11 more

Open access · goldAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
3.3field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Feasibility and effectiveness of the novel HemoClear microfiltration cell-salvage system in cesarean sections in South Africa.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
    Article
  4. Review
  5. Patient Blood Management in Pregnancy.Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie · 2023
    Review
  6. Review
  7. Management of Postpartum Haemorrhage.Turkish journal of anaesthesiology and reanimation · 2022
    Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors at 12 institutions in 1 country.

Carol McLoughlinHealth Economics Unit, University of Birmingham, Birmingham, UK.ORCID 0000-0002-6861-8259
Tracy E RobertsHealth Economics Unit, University of Birmingham, Birmingham, UK.
Louise J JacksonHealth Economics Unit, University of Birmingham, Birmingham, UK.
Philip MooreSelwyn Crawford Department of Anaesthetics, Birmingham Women's Hospital, Birmingham, UK.
Matthew WilsonSchool of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
Richard HooperPragmatic Clinical Trials Unit, Centre for Primary Care & Public Health, Queen Mary University of London, London, UK.
Shubha AllardHaematology, Barts Health NHS Trust and NHS Blood and Transplant, London, UK.
Ian WrenchDepartmentof Anaesthesia (Northern General Hospital), SheffieldTeaching Hospitals NHS Foundation Trust, Sheffield, UK.
Lee BeresfordPragmatic Clinical Trials Unit, Centre for Primary Care & Public Health, Queen Mary University of London, London, UK.
James GeogheganSelwyn Crawford Department of Anaesthetics, Birmingham Women's Hospital, Birmingham, UK.
Jane DanielsNottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK.
Sue CatlingDepartment of Obstetrics, Singleton Hospital, Swansea, UK.
Vicki A ClarkSimpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK.
Paul AyukWomen's Services, RoyalVictoria Infirmary, Newcastle upon Tyne, UK.
Stephen RobsonInstitute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK.
Fang Gao-SmithPerioperative, Critical Care and Trauma Trials Group, University of Birmingham, Birmingham, UK.
Matthew HoggBarts Health NHS Trust, Royal London Hospital, London, UK.
Doris LanzWomen's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Julie DoddsWomen's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Khalid S KhanWomen's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
SALVO study group
Queen Mary University of London · GBUniversity of Birmingham · GBBirmingham Women's Hospital · GBBarts Health NHS Trust · GBEdinburgh Royal Infirmary · GBNewcastle University · GBNHS Blood and Transplant · GBNorthern General Hospital · GBRoyal Victoria Infirmary · GBSingleton Hospital · GBUniversity of Nottingham · GBUniversity of Sheffield · GB

Funding

Department of Health 10/57/32
6 · The paper itself

Abstract

objectivesTo evaluate the cost-effectiveness of routine use of cell salvage during caesarean section in mothers at risk of haemorrhage compared with current standard of care.

designModel-based cost-effectiveness evaluation alongside a multicentre randomised controlled trial. Three main analyses were carried out on the trial data: (1) based on the intention-to-treat principle; (2) based on the per-protocol principle; (3) only participants who underwent an emergency caesarean section.

setting26 obstetric units in the UK.

participants3028 women at risk of haemorrhage recruited between June 2013 and April 2016.

interventionsCell salvage (intervention) versus routine care without salvage (control). PRIMARY OUTCOME MEASURES: Cost-effectiveness based on incremental cost per donor blood transfusion avoided.

resultsIn the intention-to-treat analysis, the mean difference in total costs between cell salvage and standard care was £83. The estimated incremental cost-effectiveness ratio (ICER) was £8110 per donor blood transfusion avoided. For the per-protocol analysis, the mean difference in total costs was £92 and the ICER was £8252. In the emergency caesarean section analysis, the mean difference in total costs was £55 and the ICER was £13 713 per donor blood transfusion avoided. This ICER is driven by the increased probability that these patients would require a higher level of postoperative care and additional surgeries. The results of these analyses were shown to be robust for the majority of deterministic sensitivity analyses.

conclusionsThe results of the economic evaluation suggest that while routine cell salvage is a marginally more effective strategy than standard care in avoiding a donor blood transfusion, there is uncertainty in relation to whether it is a less or more costly strategy. The lack of long-term data on the health and quality of life of patients in both arms of the trial means that further research is needed to fully understand the cost implications of both strategies. TRIAL REGISTRATION NUMBER: ISRCTN66118656.

Indexed as

Blood TransfusionCesarean SectionCost-Benefit AnalysisFemaleHemorrhageHumansOperative Blood SalvagePregnancyQuality-Adjusted Life YearsQuality of LifeUnited Kingdomclinical trialshealth economicsmaternal medicine

Identifiers

PMID30782867
PMCPMC6398743
OpenAlexW2913583296

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.