Cost‐effectiveness of prion filtration of red blood cells to reduce the risk of transfusion‐transmitted variant Creutzfeldt‐Jakob disease in the Republic of Ireland

Teljeur, Conor; Flattery, Martin; Harrington, Patricia; O’Neill, Michelle; Moran, Patrick; Murphy, L; Ryan, Máirín

doi:10.1111/j.1537-2995.2012.03637.x

Cited by 15 publications

(5 citation statements)

References 29 publications

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“…No such cost-utility threshold is set for interventions or policies claiming to increase safety, therefore practices that offer very poor returns on investment can be promoted or even mandated; for example, prion-removing blood filters to prevent Creutzfeldt-Jacob Disease transmission from trans fusions were estimated to cost €3•7 million per QALY. 67 Similarly, no consideration is given to what mass of CO₂e per QALY gained is acceptable. There is no clear correlation coefficient to convert environmental damage to loss of QALYs at the population level that could be factored into cost-utility analyses, but it would seem intuitive that there should be a carbon cost per QALY that is unacceptable, both for interventions that claim to promote safety and for those that offer improved outcomes, just as there are financial costs per QALY thresholds.…”

Section: Balance Of Risksmentioning

confidence: 99%

Addressing the environmental sustainability of eye health-care delivery: a scoping review

Thiel

Steyn

Somner

et al. 2022

The Lancet Planetary Health

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Section: Balance Of Risksmentioning

confidence: 99%

Addressing the environmental sustainability of eye health-care delivery: a scoping review

Thiel

Steyn

Somner

et al. 2022

The Lancet Planetary Health

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“…Filters intended to remove TSE prions from blood or plasma have been developed, but laboratory studies to assess their usefulness were inconclusive . Such filters were evaluated for potential use in the UK and the Republic of Ireland , but were not recommended for adoption. Currently, available methods for pathogen reduction of blood components are not effective against TSE infectivity.…”

Section: Blood Safety Response and Efficacy Of Risk Mitigation Stratementioning

confidence: 99%

Creutzfeldt‐Jakob disease and blood transfusion safety

et al. 2018

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Transmissible spongiform encephalopathies (TSEs) are untreatable, fatal neurologic diseases affecting mammals. Human disease forms include sporadic, familial and acquired Creutzfeldt-Jakob disease (CJD). While sporadic CJD (sCJD) has been recognized for near on 100 years, variant CJD (vCJD) was first reported in 1996 and is the result of food-borne transmission of the prion of bovine spongiform encephalopathy (BSE, 'mad cow disease'). Currently, 230 vCJD cases have been reported in 12 countries, the majority in the UK (178) and France (27). Animal studies demonstrated highly efficient transmission of natural scrapie and experimental BSE by blood transfusion and fuelled concern that sCJD was potentially transfusion transmissible. No such case has been recorded and case-control evaluations and lookback studies indicate that, if transfusion transmission occurs at all, it is very rare. In contrast, four cases of apparent transfusion transmission of vCJD infectivity have been identified in the UK. Risk minimization strategies in response to the threat of vCJD include leucodepletion, geographically based donor deferrals and deferral of transfusion recipients. A sensitive and specific, high-throughput screening test would provide a potential path to mitigation but despite substantial effort no such test has yet appeared. The initial outbreak of vCJD appears to be over, but concern remains about subsequent waves of disease among those already infected. There is considerable uncertainty about the size of the infected population, and there will be at least a perception of some continuing risk to blood safety. Accordingly, at least some precautionary measures will remain in place and continued surveillance is necessary.

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“…In 2004, Custer published a useful review highlighting different economic evaluations of blood safety interventions that follow each of these forms of analysis. In addition, there are several examples of recent cost–effectiveness analyses in transfusion medicine, including assessments of allogeneic red blood cell transfusions for severe anemia, of pathogen inactivation for reducing transfusion‐transmitted infections, of single‐donor platelets (PLTs) versus pooled random‐donor PLTs, of prion filtration to reduce transfusion‐transmitted Creutzfeldt‐Jakob disease, and of using PLT additive solution to prevent allergic transfusion reactions . In the next article of this series, we will discuss developing a model for economic evaluations.…”

Section: Defining the Formmentioning

confidence: 99%

Establishing a framework: economic evaluations in transfusion medicine,Part 2

2013

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T his is the second of a four-part series on the use of economic evaluations in the field of transfusion medicine. In light of substantial and growing costs of health care, economic evaluations are increasingly used to inform health-related decisions and policies in the context of limited resources. As discussed in the first article of this series, 1 costs associated with transfusion encompass a broad range of components and involve multiple individuals and groups (i.e., patients, donors, blood suppliers, hospitals). Constructing a framework for an evaluation is a critical first step to any analysis. In this article, we discuss the process of defining such an analytical framework. HYPOTHETICAL EXAMPLETo further understand these analyses, consider a hypothetical scenario: a new donor screening test is available to identify individuals who may not be clinically symptomatic, but may transmit a newly discovered bloodborne pathogen in transfused blood. The test is 99% sensitive; excluding donors who test positive will largely ensure that this pathogen is not transmitted via the blood supply. Furthermore, the test is 90% specific; a portion of individuals without the pathogen will falsely test positive. While most (75%) pathogen-infected individuals will not experience clinical symptoms, symptomatic individuals experience mild or severe effects. Among the symptomatic individuals, 10% experience severe effects, which are associated with substantial costs for treatment and management. However, the screening test itself is expensive to implement and would require additional equipment and time from technicians. Hospital and blood bank management needs to evaluate the costs and effectiveness of implementing this test.Under this simplified scenario, economic evaluations will primarily compare two strategies: the current standard of care (not using the test) and an alternative proposal (implementing the test in hospitals). DEFINING THE PROBLEMAny economic evaluation must clearly define the problem being assessed, the perspective of the analysis, and the outcomes of interest. In the event that a new program or policy is being considered, the proposed strategy (or technology, intervention, program, policy, etc.) is compared to an alternative, which often reflects a "baseline" strategy characterizing the currently implemented method. For each evaluated strategy, expected costs, health outcomes, or both would be assessed, and these outcomes would be compared to determine which strategy, if any, is preferred. Consider, for example, the decision a transfusion service must make in determining whether or not to provide transfusion patients with a new prophylactic medication to prevent transfusion reactions. Expected outcomes after implementing the new prophylactic medication would be compared to the current method (perhaps a different medication or none at all). The optimal strategy would then be determined based on these outcomes.In addition to defining of a broader research question, the perspective of the analysis needs to be spec...

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Cost‐effectiveness of prion filtration of red blood cells to reduce the risk of transfusion‐transmitted variant Creutzfeldt‐Jakob disease in the Republic of Ireland

Abstract: Prion filtration is considered not cost-effective by traditional measures. Although numerous non-cost-effective blood safety strategies have been implemented in the past, consideration should be given to the most efficient use of finite resources in transfusion medicine.

Cited by 15 publications

References 29 publications

Addressing the environmental sustainability of eye health-care delivery: a scoping review

Addressing the environmental sustainability of eye health-care delivery: a scoping review

Creutzfeldt‐Jakob disease and blood transfusion safety

Establishing a framework: economic evaluations in transfusion medicine,Part 2

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