We appreciate the interest in our work, “Utility of Cell Salvage in Women Undergoing Abdominal Myomectomy.” The goal of our analysis was to examine the trends in set-up of cell salvage in women who undergo myomectomy, to estimate the frequency with which cell-salvaged blood was reinfused, and to explore the institution-specific costs that are associated with the use of cell salvage. The major findings from our work were that cell salvage was frequently used but that the blood collected at the time of the procedure was used infrequently. Further, we were unable to reliably develop a model to predict which patients would benefit from the availability of the cell salvage device. Under the conditions we modeled, cell salvage generally was not found to be cost-effective.

We acknowledge that our cost analysis relied on institutional practice patterns and cost estimates. Cost for interventions such as cell salvage are highly variable and are influenced by a number of factors that often vary at different centers. As pointed out, at our institution, perfusionists are used to assist with cell salvage, which is a practice that is certainly not universal. Aside from the variable costs associated with the personnel and equipment to implement cell salvage, a number of other concerns exist with estimating the cost of cell salvage. Currently, there is no consensus on when the transfusion of cell-salvaged blood is indicated; there is growing recognition that moderate anemia is well tolerated in healthy patients which makes use of a transfusion “cut off” in cost analyses imprecise. The short- and long-term complications of allogeneic transfusion must be included when estimating risk-benefit ratios.

Given the frequency with which myomectomy is performed along with the importance of containing costs, we hope this work will stimulate further studies to help define the role of cell in women who undergo myomectomy.