The cost‐effectiveness of screening blood donors for malaria by PCR

Shehata, Nadine; Kohli, Michele; Detsky, Allan S.

doi:10.1111/j.1537-2995.2004.00644.x

Cited by 32 publications

(25 citation statements)

References 17 publications

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“…Since WNV assays have not yet been priced, we estimated their cost from studies of similar assays for other viruses. Other screening costs were obtained from state laboratories (R. Timperi, personal communication) and could be corroborated with data from a screening study [26] for transfusion-acquired malaria in Canada.…”

Section: Methodsmentioning

confidence: 82%

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

Korves

Goldie²,

Murray

2006

PLoS Med

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BackgroundWest 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.Methods and FindingsWe 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 US$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.ConclusionsIn 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.

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Section: Methodsmentioning

confidence: 82%

“…The cost estimates [26–28] used in the base case are shown in Table 2. Direct costs for screening blood donors using WNV assays included screening kit and reagents, laboratory technician fees, and the costs of a discarded false positive, donor notification, and retrieval of a test-positive sample.…”

Section: Methodsmentioning

confidence: 99%

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

Korves

Goldie²,

Murray

2006

PLoS Med

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“…We believe, on the basis of our results, that detection of plasmodial DNA by the first step of nested-PCR, as has already been described in the detection of the Plasmodium genus 13 , would be enough to identify APCs with P. falciparum, P. vivax and P. malariae, thus reducing the costs of analysis in Brazilian blood banks. Furthermore, its cost-effectiveness was already approved in a Canadian study by a decision analysis model 18 . Additionally, the optimum strategy for minimizing the risk of transfusion-transmitted malaria in Brazilian endemic areas is a combination of appropriate donor selection together with donation screening using PCR and other laboratory methods.…”

Section: Discussionmentioning

confidence: 99%

Molecular screening of Plasmodium sp. asymptomatic carriers among transfusion centers from Brazilian Amazon region

Fugikaha

Fornazari

Penhalbel

et al. 2007

Rev. Inst. Med. trop. S. Paulo

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SUMMARYThe transmission of malaria in Brazil is heterogeneous throughout endemic areas and the presence of asymptomatic Plasmodium sp. carriers (APCs) in the Brazilian Amazon has already been demonstrated. Malaria screening in blood banks is based on the selection of donors in respect to possible risks associated with travel or residence, clinical evidence and/or inaccurate diagnostic methods thereby increasing the probability of transfusion-transmitted infection. We evaluated the frequency of APCs in four blood services in distinct areas of the Brazilian Amazon region. DNA was obtained from 400 human blood samples for testing using the phenol-chloroform method followed by a nested-PCR protocol with species-specific primers. The positivity rate varied from 1 to 3% of blood donors from the four areas with an average of 2.3%. All positive individuals had mixed infections for Plasmodium vivax and Plasmodium falciparum. No significant differences in the results were detected among these areas; the majority of cases originated from the transfusion centres of Porto Velho, Rondônia State and Macapá, Amapá State. Although it is still unclear whether APC individuals may act as reservoirs of the parasite, efficient screening of APCs and malaria patients in Brazilian blood services from endemic areas needs to be improved.

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“…Compared to not using a medical questionnaire, the incremental cost-effectiveness ratio was $6,463 per case of malaria averted when using the medical questionnaire followed by PCR. 30 A third analysis was a costbenefit analysis with an implicit valuation of Israel's decision (in 1990s) to exclude blood donations from Ethiopian immigrants, due to the high prevalence of HIV infection in this community relative to the rest of the Israeli population. This analysis demonstrated that this exclusion policy could not be considered as justifiable on public health grounds if the annual social exclusion costs exceed $218,000 per year or $3.63 per Ethiopian immigrant.…”

Section: Health Technology Assessmentsmentioning

confidence: 99%

Blood donor deferral: time for change? An evidence-based analysis

Borra¹,

Vandewalle²,

Remoortel³

et al. 2016

IJCTM

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Donor selection remains an important part in the safety of the blood supply all over the world. Yet, donor deferral criteria seem to be strongly based on the precautionary principle protecting safety and quality, and on supply and expense considerations. This review therefore provides an overview of the available evidence on donor exclusion criteria, as well as on their cost-effectiveness, for the most frequent reasons of donor deferral in our region. PubMed was queried to retrieve primary research studies, systematic reviews, and health technology assessments (HTAs) concerning donor exclusion criteria. With a similar approach, HTAs about the different blood-banking safety interventions were included. Reasons for donor deferral were recorded via the blood bank information system of the Belgian Red Cross-Flanders. Seven systematic reviews were identified: four on donor safety (hypotension, hypertension/type 2 diabetes, epilepsy, and higher age) and three on recipient safety (hemochromatosis, men who have sex with men, and endoscopy). Forty-three lowquality observational studies were included, as well as 16 HTAs: three about donor exclusion criteria and 13 cost-utility analyses about blood-banking safety interventions. In general, the available evidence for deferral reasons was of low quality, and for 60% of the top 30 reasons for excluding donors, no evidence was found. Blood banking shows its unique position as many safety measures far exceed the normally accepted cost of €50,000/quality-adjusted life-years. The historical model based on the precautionary principle and on supply and expense considerations provides adequate supplies of safe blood at a reasonable price. More and better primary research and evidence-based analyses are required, however, before this model can be replaced by an evidence-based approach. Meanwhile, policy makers should provide guidance at the level of principles, not at the level of technical measures, about the balance between patient and donor rights, and about the acceptable cost-effectiveness implications of these choices.

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The cost‐effectiveness of screening blood donors for malaria by PCR

Abstract: The addition of PCR to the standard screening questionnaire is economically attractive compared to the current standard screening questionnaire.

Cited by 32 publications

References 17 publications

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

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

Molecular screening of Plasmodium sp. asymptomatic carriers among transfusion centers from Brazilian Amazon region

Blood donor deferral: time for change? An evidence-based analysis

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