Cost-effectiveness of HIV screening of blood donations in Accra (Ghana).
OBJECTIVE
Areas with high HIV-incidence rates compared to the developed world may benefit from additional testing in blood banks and may show more favorable cost-effectiveness ratios. We evaluated the cost-effectiveness of adding p24 antigen, mini pool nucleic acid amplification testing (MP-NAT), or individual donation NAT (ID-NAT) to the HIV-antibody screening at the Korle Bu Teaching Hospital (Accra, Ghana), where currently only HIV-antibody screening is undertaken.


METHODS
The residual risk of HIV transmission was derived from blood donations to the blood bank of the Korle Bu Teaching Hospital in 2004. Remaining life expectancies of patients receiving blood transfusion were estimated using the World Health Organization life expectancies. Cost-effectiveness ratios for adding the tests to HIV-antibody screening only were determined using a decision tree model and a Markov model for HIV.


RESULTS
The prevalence of HIV was estimated at 1.51% in 18,714 donations during 2004. The incremental cost per disability-adjusted life-year (DALY) averted was US$1237 for p24 antigen, US$3142 for MP-NAT and US$7695 compared to the next least expensive strategy. HIV-antibody screening itself was cost-saving compared to no screening at all, gaining US$73.85 and averting 0.86 DALY per transfused patient. Up to a willingness-to-pay of US$2736 per DALY averted, HIV-antibody screening without additional testing was the most cost-effective strategy. Over a willingness-to-pay of US$11,828 per DALY averted, ID-NAT was significantly more cost-effective than the other strategies.


CONCLUSIONS
Adding p24 antigen, MP-NAT, or ID-NAT to the current antibody screening cannot be regarded as a cost-effective health-care intervention for Ghana.
van Hulst
Marinus
M
Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands. m.van.hulst@rug.nl
Sagoe
Kwamena W C
KW
Vermande
Jacobien E
JE
van der Schaaf
Ido P
IP
van der Tuuk Adriani
Willem P A
WP
Torpey
Kwasi
K
Ansah
Justina
J
Mingle
Julius A A
JA
Smit Sibinga
Cees Th
CT
Postma
Maarten J
MJ
D001782:Blood Donors; D001803:Blood Transfusion / Q000592:standards*; D003906:Developing Countries; D005869:Ghana / Q000453:epidemiology; D015483:HIV Antibodies / Q000097:blood* / Q000191:economics; D016655:HIV Core Protein p24 / Q000032:analysis / Q000191:economics; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D015995:Prevalence
D015483:HIV Antibodies; D016655:HIV Core Protein p24