Removing hepatitis C antibody testing for Australian blood donations: A cost‐effectiveness analysis

Abstract

Background and Objectives The risk of transfusion‐transmitted hepatitis C virus (HCV) infections is extremely low in Australia. This study aims to conduct a cost‐effectiveness analysis of different testing strategies for HCV infection in blood donations. Materials and Methods The four testing strategies evaluated in this study were universal testing with both HCV antibody (anti‐HCV) and nucleic acid testing (NAT); anti‐HCV and NAT for first‐time donations and NAT only for repeat donations; anti‐HCV and NAT for transfusible component donations and NAT only for plasma for further manufacture; and universal testing with NAT only. A decision‐analytical model was developed to assess the cost‐effectiveness of alternative HCV testing strategies. Sensitivity analysis and threshold analysis were conducted to account for data uncertainty. Results The number of potential transfusion‐transmitted cases of acute hepatitis C and chronic hepatitis C was approximately zero in all four strategies. Universal testing with NAT only was the most cost‐effective strategy due to the lowest testing cost. The threshold analysis showed that for the current practice to be cost‐effective, the residual risks of other testing strategies would have to be at least 1 HCV infection in 2424 donations, which is over 60,000 times the baseline residual risk (1 in 151 million donations). Conclusion The screening strategy for HCV in blood donations currently implemented in Australia is not cost‐effective compared with targeted testing or universal testing with NAT only. Partial or total removal of anti‐HCV testing would bring significant cost savings without compromising blood recipient safety.

Is dual testing for hepatitis C necessary? Modelling the risk of removing hepatitis C antibody testing for Australian blood donations

“…Although complete cessation of anti-HCV testing has operational advantages and is the most cost-effective [10], there are reasons why first-time donor testing may be regarded as the optimal initial change.…”

“…Lifeblood remains committed to providing both a safe and cost-justified service to the Australian public, which has prompted consideration of alternative screening testing strategies in the changing HCV context. This study models the risk of transfusion-transmitted HCV in four alternative testing strategies, enabling a subsequent economic analysis of cost effectiveness [10] to determine the optimal HCV testing strategy.…”

“…This study models the risk of transfusion‐transmitted HCV in four alternative testing strategies, enabling a subsequent economic analysis of cost effectiveness [ 10 ] to determine the optimal HCV testing strategy.…”

Comparison of effectiveness and cost of different HCV testing strategies in high‐risk populations in China

“…And the diagnostic window period can be shortened by using HCV nucleic acid assays. Therefore, the diagnostic strategy for HCV infection in some laboratories is to perform HCV nucleic acid testing, followed by HCV antibody testing, to avoid the phenomenon of missed detection in patients with early HCV infection 14 …”

“…Therefore, the diagnostic strategy for HCV infection in some laboratories is to perform HCV nucleic acid testing, followed by HCV antibody testing, to avoid the phenomenon of missed detection in patients with early HCV infection. 14 At present, there are numerous choices available for the testing strategy of HCV, encompassing various methods and degrees of complexity to meet the needs of different regions and populations. To determine the most suitable testing strategy, it is necessary to consider factors such as epidemiological characteristics, available resources, technical requirements, and costeffectiveness.…”