Cost-effectiveness of testing for human immunodeficiency virus and hepatitis C virus among blood transfusion recipients.
OBJECTIVE
To choose the most cost-effective option for detecting human immunodeficiency virus (HIV-1) and hepatitis C virus (HCV) among blood transfusion recipients.


METHODS
Cost-effectiveness analysis. Effectiveness was expressed as the number of HIV-1 or HCV infections detected, regardless of whether they were related to transfusion. To estimate costs, we assumed hospital insurance would cover costs related to detection and compensation, when granted.


METHODS
A 2,890-bed acute care teaching hospital in Bordeaux, France.


METHODS
Eight options were defined, from the simplest, which would be to do nothing, to a maximal approach, which would be to keep a serum sample in a serum library for a lookback and perform tests for antibody to HIV-1 and to HCV before and 3 months after transfusion. Data on probabilities and costs were taken from the literature and experiences of French hospitals.


RESULTS
The most cost-effective option was to perform viral antibody testing before transfusions (option 3), which would detect 27 infections per 1,000 patients, for an expenditure of US $1,260 per detected patient Option 6, obtaining a serum sample before transfusion and performing tests for antibody to HIV-1 and to HCV 3 months after transfusion, had a similar cost-effectiveness ratio but detected only 16 infections per 1,000 patients. Performing tests before and 3 months after transfusion (option 4), compared with option 3, would detect 1 additional infection for an additional cost of US $8,322.


CONCLUSIONS
The most cost-effective options are not specific to blood transfusion recipients and might be more suited to all hospitalized patients.
Mathoulin-Pelissier
Simone
S
Institute of Public Health, Epidemiology, and Development, Bordeaux, France.
Salmi
Louis-Rachid
LR
Fialon
Pierre
P
Salamon
Roger
R
D015492:AIDS Serodiagnosis / Q000191:economics; D015415:Biomarkers; D017848:Blood-Borne Pathogens; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005602:France / Q000453:epidemiology; D015483:HIV Antibodies / Q000097:blood*; D015658:HIV Infections / Q000175:diagnosis / Q000209:etiology / Q000276:immunology* / Q000401:mortality; D006526:Hepatitis C / Q000175:diagnosis / Q000209:etiology / Q000276:immunology* / Q000401:mortality; D018937:Hepatitis C Antibodies / Q000097:blood*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000191:economics*; D006801:Humans; D011336:Probability; D018570:Risk Assessment; D012698:Serologic Tests / Q000191:economics*; D065227:Transfusion Reaction
D015415:Biomarkers; D015483:HIV Antibodies; D018937:Hepatitis C Antibodies