John D. Birkmeyer, MD, Assistant Professor, Departments of Surgery and of Community and Family Medicine, Dartmouth-Hitchcock Medical Center
Cost-effectiveness of expanded human immunodeficiency virus-testing protocols for donated blood
Article first published online: 27 FEB 2003
Volume 37, Issue 1, pages 45–51, January 1997
How to Cite
AuBuchon, J.P., Birkmeyer, J.D. and Busch, M.P. (1997), Cost-effectiveness of expanded human immunodeficiency virus-testing protocols for donated blood. Transfusion, 37: 45–51. doi: 10.1046/j.1537-2995.1997.37197176950.x
- Issue published online: 27 FEB 2003
- Article first published online: 27 FEB 2003
- Received for publication April 26, 1996, and accepted June 28, 1996.
BACKGROUND: This study was designed to estimate the cost-effectiveness of expanding the human immunodeficiency virus (HIV)-testing protocol for donated blood beyond screening for HIV antibodies to further reduce the risk of HIV transmission through transfusion.
STUDY DESIGN AND METHODS: A Markov decision analysis model was developed to estimate the cost-effectiveness of HIV antibody testing (at a cost of $5/unit) and of adding to that protocol a second HIV test, either plasma p24 antigen detection or RNA polymerase chain reaction (PCR) (at costs of $5/unit and $8/unit, respectively). Test efficacy was projected from anticipated window-period reductions (6 days for p24 antigen, 11 days for RNA PCR), and donor seroconversion rates were derived from the Retrovirus Epidemiology Donor Study.
RESULTS: On the basis of current estimates of HIV prevalence rates in blood donors (1/10,000) and 16 million annual transfusions in the United States HIV antibody testing prevents 1568 cases of transfusion-acquired HIV infection each year at a cost of $3600 per quality-adjusted year of life saved. The addition of p24 antigen testing would prevent 8 more cases at a net additional cost of $60 million annually ($2.3 million/quality-adjusted life year); RNA PCR testing would prevent 16 more cases at a net additional cost of $96 million annually ($2.0 million/ quality-adjusted life year).
CONCLUSION: Although expanding the donor HIV screening protocol with p24 antigen or RNA PCR testing will prevent rare cases of transfusion-associated HIV, the cost-effectiveness of such an addition is predicted to be far below that of most medical interventions. Thus, HIV test protocol additions are unlikely to provide cost-effective improvements to blood safety in the United States.