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The cost‐effectiveness of NAT for HIV, HCV, and HBV in whole‐blood donations
Author(s) -
Jackson B.R.,
Busch M.P.,
Stramer S.L.,
AuBuchon J.P.
Publication year - 2003
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1046/j.1537-2995.2003.00392.x
Subject(s) - nat , medicine , blood donations , residual risk , window period , hepatitis b , hepatitis b virus , blood donor , human immunodeficiency virus (hiv) , blood transfusion , cost effectiveness , environmental health , virology , immunology , virus , antibody , serology , computer network , risk analysis (engineering) , computer science
BACKGROUND : The risk of viral infection associated with blood transfusion is lower than ever before because of aggressive screening and testing practices. NAT technology has lowered that risk even further but at an additional cost to the health‐care system. STUDY DESIGN AND METHODS : Marginal cost‐effectiveness of NAT for HIV, HCV, and HBV in whole‐blood donations was calculated with a previously published Markov decision model. This model was updated with disease incidence data from all 2001 American Red Cross whole‐blood donations as well as window‐period data from the Retrovirus Epidemiology Donor Study (REDS). RESULTS : Whole‐blood donation NAT for HIV and HCV is expected to cost between $155 million (minipool NAT) and $428 million (single‐donation NAT) per year in the US and avert 4 to 7 HIV infections and 56 to 59 HCV infections. Adding HBV NAT would be expected to avert 9 to 37 HBV infections at an additional cost of between $39 million and $130 million per year. Overall, NAT would cost between $4.7 million and $11.2 million per quality‐adjusted life‐year saved. Discontinuing HIV p24 antigen and HBc testing would offset this somewhat. CONCLUSIONS : The cost‐effectiveness of whole‐blood NAT is poor. The testing cost would need to decrease significantly to bring the cost‐effectiveness in line with most other accepted medical practices.