Preliminary findings were presented at the 34th Annual Meeting of the Society for Medical Decision Making in Phoenix, AZ, in October 2012.
DONOR-RELATED INFECTION RISK
Cost-effectiveness of blood donor screening for Babesia microti in endemic regions of the United States
Article first published online: 19 NOV 2013
© 2013 American Association of Blood Banks
Special Issue: Donating Blood: Who? Why? What of It?
Volume 54, Issue 3pt2, pages 889–899, March 2014
How to Cite
Simon, M. S., Leff, J. A., Pandya, A., Cushing, M., Shaz, B. H., Calfee, D. P., Schackman, B. R. and Mushlin, A. I. (2014), Cost-effectiveness of blood donor screening for Babesia microti in endemic regions of the United States. Transfusion, 54: 889–899. doi: 10.1111/trf.12492
- Issue published online: 11 MAR 2014
- Article first published online: 19 NOV 2013
- Manuscript Accepted: 30 SEP 2013
- Manuscript Revised: 10 SEP 2013
- Manuscript Received: 20 JUN 2013
- Clinical and Translational Science Center at Weill Cornell Medical College. Grant Number: UL1 TR000457
Babesia microti is the leading reported cause of red blood cell (RBC) transfusion-transmitted infection in the United States. 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 Babesia-endemic areas of the United States. Strategies included: 1) no screening; 2) Uniform Donor Health History Questionnaire (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 (QALYs), and incremental cost-effectiveness ratios (ICERs; $/QALY). We assumed a societal willingness to pay of $1 million/QALY based on screening for other transfusion-transmitted infections.
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 Babesia prevalence, TTB transmission probability, screening test costs, risk and severity of TTB complications, and impact of babesiosis diagnosis on donor quality of life.
Antibody screening for Babesia in endemic regions is appropriate from an economic perspective based on the societal willingness to pay for preventing infectious threats to blood safety.