In:
Transfusion, Wiley, Vol. 55, No. 9 ( 2015-09), p. 2256-2271
Abstract:
Babesia microti causes transfusion‐transmitted babesiosis (TTB); currently, blood donor screening assays are unlicensed but used investigationally. STUDY DESIGN AND METHODS We developed a decision tree model assessing the comparative‐ and cost‐effectiveness of B. microti blood donation screening strategies in endemic areas compared to the status quo (question regarding a history of babesiosis), including testing by: 1) universal antibody (Ab), 2) universal polymerase chain reaction (PCR), 3) universal Ab/PCR, and 4) recipient risk–targeted Ab/PCR. The model predicted the number of TTB cases, complicated TTB cases, cases averted, and quality‐adjusted life years (QALYs). Economic outcomes included each strategy's per‐donation cost, waste (number of infection‐free units incorrectly discarded), and waste index (number wasted units/number true positives). Sensitivity analyses examined uncertainty in transmission probabilities, prevalence rates, and other key model inputs. RESULTS Universal PCR in four endemic states would prevent 24 to 31 TTB cases/100,000 units transfused (pht) at an incremental cost‐effectiveness ratio (ICER) of $26,000 to $44,000/QALY (transmission probability dependent) and waste index of zero. Universal Ab/PCR would prevent 33 to 42 TTB cases pht at an ICER of $54,000 to $83,000/QALY and waste index of 0.05. The questionnaire is most wasteful (99.62 units wasted pht; 208.62 waste index), followed by the risk‐targeted strategy (76.27 units wasted pht; 0.68 waste index). The model predicted zero cases of TTB or complicated TTB with universal Ab/PCR (versus [33, 42] and [13, 18] pht, respectively [no screening]). Results are highly sensitive to transmission probabilities. CONCLUSIONS Universal PCR in endemic states is an effective blood donation screening strategy at a threshold of $50,000/QALY. Using a higher cost‐effectiveness ratio, universal Ab/PCR is the most effective strategy.
Type of Medium:
Online Resource
ISSN:
0041-1132
,
1537-2995
DOI:
10.1111/trf.2015.55.issue-9
Language:
English
Publisher:
Wiley
Publication Date:
2015
detail.hit.zdb_id:
2018415-3
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