Article

Cost-Effectiveness of Alternative Blood-Screening Strategies for West Nile Virus in the United States

New York City Department of Health and Mental Hygiene United States of America
PLoS Medicine (Impact Factor: 14). 03/2006; 3(2):e21. DOI: 10.1371/journal.pmed.0030021
Source: PubMed

ABSTRACT West Nile virus (WNV) is endemic in the US, varying seasonally and by geographic region. WNV can be transmitted by blood transfusion, and mandatory screening of blood for WNV was recently introduced throughout the US. Guidelines for selecting cost-effective strategies for screening blood for WNV do not exist.
We conducted a cost-effectiveness analysis for screening blood for WNV using a computer-based mathematical model, and using data from prospective studies, retrospective studies, and published literature. For three geographic areas with varying WNV-transmission intensity and length of transmission season, the model was used to estimate lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios associated with alternative screening strategies in a target population of blood-transfusion recipients. We compared the status quo (baseline screening using a donor questionnaire) to several strategies which differed by nucleic acid testing of either pooled or individual samples, universal versus targeted screening of donations designated for immunocompromised patients, and seasonal versus year-long screening. In low-transmission areas with short WNV seasons, screening by questionnaire alone was the most cost-effective strategy. In areas with high levels of WNV transmission, seasonal screening of individual samples and restricting screening to blood donations designated for immunocompromised recipients was the most cost-effective strategy. Seasonal screening of the entire recipient pool added minimal clinical benefit, with incremental cost-effectiveness ratios exceeding USD 1.7 million per quality-adjusted life-year gained. Year-round screening offered no additional benefit compared to seasonal screening in any of the transmission settings.
In areas with high levels of WNV transmission, seasonal screening of individual samples and restricting screening to blood donations designated for immunocompromised recipients is cost saving. In areas with low levels of infection, a status-quo strategy using a standard questionnaire is cost-effective.

0 Bookmarks
 · 
75 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Arthropod-borne viruses (arboviruses) are a growing threat to global health. Complex vector–virus–host interactions lead to unpredictable epidemiological patterns. Difficulties in accurate surveillance including imperfect diagnostic tools impair effective response to outbreaks. With arboviral infections causing a wide spectrum of disease severity, from asymptomatic infection to fatal neuroinvasive and haemorrhagic fevers, the potential impact on blood safety is significant. Asymptomatic or presymptomatic individuals may introduce virus into the blood supply by donation, while recipients can potentially suffer severe consequences. Dengue, West Nile and chikungunya outbreaks have led to responses by blood transfusion services which can inform future planning. Reports of transfusion-associated transmission demonstrate the potentially fatal consequences of lack of haemovigilance. South-East Asia remains vulnerable to arboviruses with permissive climate and high levels of endemic transmission as well as the potential for emerging and re-emerging arboviral diseases. Resource limitations constrain the use of expensive technologies for donor screening. Continued surveillance and research will be required to manage the arboviral threat to the blood supply.
    ISBT Science Series 07/2013; 9(1). DOI:10.1111/voxs.12083
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Babesia microti is the leading reported cause of red blood cell (RBC) transfusion-transmitted infection in the United States. Donor screening assays are in development. A decision analytic model estimated the cost-effectiveness of screening strategies for preventing transfusion-transmitted babesiosis (TTB) in a hypothetical cohort of transfusion recipients in Babesia-endemic areas of the United States. Strategies included: 1) no screening; 2) Uniform Donor Health History Questionnaire (UDHQ), "status quo"; 3) recipient risk targeting using donor antibody and polymerase chain reaction (PCR) screening; 4) universal endemic donor antibody screening; and 5) universal endemic donor antibody and PCR screening. Outcome measures were TTB cases averted, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs; $/QALY). We assumed a societal willingness to pay of $1 million/QALY based on screening for other transfusion-transmitted infections. Compared to no screening, the UDHQ avoids 0.02 TTB cases per 100,000 RBC transfusions at an ICER of $160,000/QALY whereas recipient risk-targeted strategy using antibody/PCR avoids 1.62 TTB cases per 100,000 RBC transfusions at an ICER of $713,000/QALY compared to the UDHQ. Universal endemic antibody screening avoids 3.39 cases at an ICER of $760,000/QALY compared to the recipient risk-targeted strategy. Universal endemic antibody/PCR screening avoids 3.60 cases and has an ICER of $8.8 million/QALY compared to universal endemic antibody screening. Results are sensitive to blood donor Babesia prevalence, TTB transmission probability, screening test costs, risk and severity of TTB complications, and impact of babesiosis diagnosis on donor quality of life. Antibody screening for Babesia in endemic regions is appropriate from an economic perspective based on the societal willingness to pay for preventing infectious threats to blood safety.
    Transfusion 11/2013; DOI:10.1111/trf.12492 · 3.57 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Blood products, derived from donated blood, are essential for many medical treatments, and their safety, in terms of being free of Transfusion-Transmitted Infections (TTIs)—i.e., infectious agents that can be spread through their use—is crucial. However, blood screening tests are not perfectly reliable and may produce false negative or false-positive results. Currently, blood donations are tested using a same-for-all testing scheme, where a single test set is used on all blood donations. This article studies differential testing schemes, which may involve multiple test sets, each applied to a randomly selected fraction of the donated blood. Thus, although each blood donation is still tested by a single test set, multiple test sets may be used by the Blood Center. This problem is modeled within an optimization framework and a novel solution methodology is provided that allows important structural properties of such testing schemes to be characterized. It is shown that an optimal differential testing scheme consists of at most two test sets, and such a dual-test scheme can significantly reduce the TTI risk over the current same-for-all testing. The presented analysis leads to an efficient greedy algorithm that generates the optimal differential test sets for a range of budgets to inform the decision-maker (e.g., Blood Center). The differential model is extended to the case where different test sets can be used on sub-sets of donations defined by donation characteristics (e.g., donor demographics, seasonality, or region) that differentiate the sub-set’s TTI prevalence rates. The risk reduction potential of differential testing is quantified through two case studies that use published data from Sub-Saharan Africa and the United States. The study generates key insight into public policy decision making on the design of blood screening schemes.
    IIE Transactions 01/2014; 46(11):1147-1168. DOI:10.1080/0740817X.2014.882038 · 1.29 Impact Factor

Preview (2 Sources)

Download
0 Downloads
Available from