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Costs, consequences, and cost‐effectiveness of strategies for B abesia microti donor screening of the US blood supply
Author(s) -
Goodell Alex J.,
Bloch Evan M.,
Krause Peter J.,
Custer Brian
Publication year - 2014
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.12805
Subject(s) - medicine , seroprevalence , population , cost effectiveness , quality adjusted life year , immunology , virology , environmental health , serology , antibody , risk analysis (engineering)
Background B abesia microti is regarded as the foremost infectious risk to the US blood supply for which a regulatory‐approved screening test is unavailable. More than 160 cases of transfusion‐transmitted B abesia microti ( TTB ) have been reported to date, yet there is little consensus regarding a mitigation strategy. Study Design and Methods This study sought to assess the cost‐utility of donation screening by mode of testing (immunofluorescence assay, enzyme‐linked immunosorbent assay [ ELISA ], polymerase chain reaction [ PCR ], and combinations thereof) as well as extent of geographic inclusion (4‐state, 7‐state, 20‐state, or national screening). A discrete‐time M arkov cohort model to simulate the outcomes of B . microti infection and survival of the transfused population was developed. Seroprevalence was estimated by extrapolating babesiosis claims from the C enters for M edicaid and M edicare S ervices and reports to the C enters for D isease C ontrol and P revention. Test performance was estimated from clinical diagnostics and limited donor screening studies, while transmissibility was estimated as a weighted average of three studies. Results are reported as the cost per quality‐adjusted life‐year ( QALY ) for each strategy compared to no screening. Results Given model inputs, 4‐state and 7‐state ELISA in combination with PCR would cost $5.2 million and $6.6 million/ QALY , respectively. Cost‐effectiveness for 20‐state and national screening strategies were less favorable. Conclusion Targeted screening in states with the highest seroprevalence of infection is likely to exceed an implicit threshold of $1 million/ QALY often used in blood safety. However, the proportion of donor‐seronegative parasitemia, transmissibility, and clinical outcomes resulting from TTB are uncertain.