• blood screening;
  • cost-effectiveness analysis;
  • decision analysis model;
  • hepatitis B;
  • hepatitis C;
  • human immunodeficiency virus

Background and Objectives  The aim of this study was to examine the cost-effectiveness of adding nucleic acid testing (NAT) to serological (antibody and antigen) screening protocols for donated blood in the United States (US) with the purpose of reducing the risks of transfusion-transmission of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV).

Materials and Methods  The costs, health consequences and cost-effectiveness of adding either minipool or individual-donor NAT to serological screening (SS) testing were estimated using a decision-analysis model.

Results  With the given modelling assumptions, adding minipool NAT would avoid an estimated 37, 128 and eight cases of HBV, HCV and HIV, respectively, and save ≈ 53 additional years of life and 102 additional quality adjusted life years (QALYs) compared with SS, at a net cost of $154 million. SS + minipool NAT − p24 compared with SS alone resulted in an incremental cost-effectiveness ratio of $1·5 million per QALY gained (range in sensitivity analysis $1·0–2·1 million per QALY gained) in this US analysis.

Conclusions  The cost effectiveness of adding NAT screening is outside the typical range for most healthcare interventions, but not for established blood safety measures.