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Cost‐effectiveness of blood donor screening for B abesia microti in endemic regions of the U nited S tates

2013; Wiley; Volume: 54; Issue: 3pt2 Linguagem: Inglês

10.1111/trf.12492

1537-2995

Matthew S. Simon, Jared A. Leff, Ankur Pandya, Melissa M. Cushing, Beth H. Shaz, David P. Calfee, Bruce R. Schackman, Alvin I. Mushlin,

Dermatological diseases and infestations

Background B abesia microti is the leading reported cause of red blood cell ( RBC ) transfusion‐transmitted infection in the U nited S tates. Donor screening assays are in development. Study Design and Methods A decision analytic model estimated the cost‐effectiveness of screening strategies for preventing transfusion‐transmitted babesiosis ( TTB ) in a hypothetical cohort of transfusion recipients in B abesia ‐endemic areas of the U nited S tates. Strategies included: 1) no screening; 2) U niform D onor H ealth H istory Q uestionnaire ( UDHQ ), “status quo”; 3) recipient risk targeting using donor antibody and polymerase chain reaction ( PCR ) screening; 4) universal endemic donor antibody screening; and 5) universal endemic donor antibody and PCR screening. Outcome measures were TTB cases averted, costs, quality‐adjusted life‐years ( QALY s), and incremental cost‐effectiveness ratios ( ICER s; $/ QALY ). We assumed a societal willingness to pay of $1 million/ QALY based on screening for other transfusion‐transmitted infections. Results Compared to no screening, the UDHQ avoids 0.02 TTB cases per 100,000 RBC transfusions at an ICER of $160,000/ QALY whereas recipient risk–targeted strategy using antibody/ PCR avoids 1.62 TTB cases per 100,000 RBC transfusions at an ICER of $713,000/ QALY compared to the UDHQ . Universal endemic antibody screening avoids 3.39 cases at an ICER of $760,000/ QALY compared to the recipient risk–targeted strategy. Universal endemic antibody/ PCR screening avoids 3.60 cases and has an ICER of $8.8 million/ QALY compared to universal endemic antibody screening. Results are sensitive to blood donor B abesia prevalence, TTB transmission probability, screening test costs, risk and severity of TTB complications, and impact of babesiosis diagnosis on donor quality of life. Conclusion Antibody screening for B abesia in endemic regions is appropriate from an economic perspective based on the societal willingness to pay for preventing infectious threats to blood safety.