The development of indications for the preoperative use of recombinant XXXX .

@entity1 @entity417 @entity66 @entity190 @entity1307 @entity102 @entity148
OBJECTIVE: To develop indications for the preoperative use of recombinant @entity1307 (rHuEPO) alone and in conjunction with preoperative autologous donation (PAD). DESIGN: A 2-round modified Delphi-consensus process. @entity1 : Nine physicians representing multiple clinical specialties, practice environments and geographic locations. METHOD: From evidence tables and a literature summary (MEDLINE database from January 1985 to August 1996) provided and using the RAND-UCLA appropriateness method, the physicians developed 264 indications for the preoperative use of rHuEPO by permuting 7 clinical factors (age, history of transfusion or antibody incompatibility, hemoglobin level, @entity417 of @entity102 , expected @entity190 , presence of cardiovascular or @entity66 and @entity1 @entity148 ). These indications were rated on a 9-point appropriateness scale. Median scores and measures of agreement were determined. OUTCOME MEASURES: The significance of cost constraints or cost and blood supply constraints and the impact of each clinical factor on the ratings as judged by statistical analysis. RESULTS: Of the 264 indications, 54% were rated appropriate, 18% uncertain and 28% inappropriate. Expected @entity190 had the greatest impact on the ratings (high expected @entity190 had a 5.9 point more appropriate rating on the 9-point scale than low expected @entity190 [p < 0.0001]). Preoperative hemoglobin level also significantly influenced the ratings (p < 0.0001). Compared with the clinical context, the ratings under the cost constraint were 1.0 less appropriate (p < 0.0001) for rHuEPO alone and 1.2 less appropriate for rHuEPO and PAD (p < 0.0001). The ratings for @entity1 with moderate expected @entity190 were significantly influenced by the cost constraint (less appropriate). CONCLUSIONS: Expected @entity190 and preoperative hemoglobin level were the best indicators of rHuEPO appropriateness. Different contexts modify the appropriateness ratings of an expensive drug like rHuEPO.
