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A model of the health and economic impact of posttransfusion hepatitis C: application to cost-effectiveness analysis of further expansion of HCV screening protocols

Authors

  • Arturo Pereira,

    1. From the Hemotherapy and Hemostasis Service, and the Blood Bank, Hospital Clínic and Augusto Pi-Sunyer Memorial Institute for Biomedical Research, Barcelona, Spain.
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  • Cristina Sanz

    1. From the Hemotherapy and Hemostasis Service, and the Blood Bank, Hospital Clínic and Augusto Pi-Sunyer Memorial Institute for Biomedical Research, Barcelona, Spain.
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  • Supported in part by Grant FIS 99/0464 from the Ministry of Health of the Government of Spain and Grant 1999ACES 00033 from the Autonomous Government of Catalonia.

Address reprint requests to: Arturo Pereira, MD, PhD, Service of Hemotherapy, Hospital Clínic, Villarroel 170, 08060 Barcelona, Spain; e-mail: apereira@clinic.ub.es.

Abstract

BACKGROUND: Cost-effectiveness analyses are needed to decide the value of further expansion of the screening protocols for HCV in blood donors. However, such analyses are hampered by imperfect knowledge of the health and economic repercussions of posttransfu-sion hepatitis C (PTHC).

STUDY DESIGN AND METHODS: A Monte Carlo simulation of a Markov model representing the outcomes of patients transfused with HCV-infective blood was used to estimate the health and economic impact of PTHC and to calculate the cost-effectiveness ratio of various HCV screening methods.

RESULTS: Median survival for hypothetical patients with PTHC and for controls without hepatitis was 11.25 and 11.75 years, respectively. Overall, 12.3 percent of patients receiving HCV-infective blood will develop chronic hepatitis, 9.3 percent will progress to liver failure, and 9.25 percent will eventually die of liver disease after a median time of 20.75 years (range, 6-70). Ninety-one percent of the infected blood recipients had no reduction in life expectancy due to PTHC, and the average loss per patient was 0.754 years. The present value of the lifetime health costs incurred by patients with PTHC is $6330 per case. HCV antibody testing increases the patients' life expectancy by 20.4 hours per blood collection tested, and it results in net savings by decreasing the number of patients that will require treatment for liver disease in the future. Adding HCV NAT increases the patients' life expectancy by 0.08 hours per blood collection tested, at a cost-effectiveness ratio of $1,829,611 per QALY gained.

CONCLUSION: PTHC has low health benefits because of the advanced age of many blood recipients. Testing donors for HCV antibodies results in net savings for the health care system, despite low health benefits. Adding HCV NAT would produce little additional gain at a very high cost.

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