title: Cost-effectiveness of additional hepatitis B virus nucleic acid testing of individual donations or minipools of six donations in the Netherlands.
abstract: BACKGROUND
  To further reduce the risk of hepatitis B virus (HBV) transmission by blood transfusion, nucleic acid testing (NAT) can be employed. The aim of this study is to estimate the incremental cost-effectiveness ratio (ICER) in the Netherlands of employing a triplex NAT assay aimed at HBV nucleic acid detection in individual donations (ID-NAT) or in minipools of 6 donations (MP-6-NAT), compared to a triplex NAT assay in minipools of 24 donations (MP-24-NAT).
  
  
  METHODS
  A mathematical model was made of the whole transfusion chain from donors to recipients of blood in the Netherlands. The annual number of avoided HBV transmissions was estimated with the window-period incidence model. The natural history of a HBV infection in recipients is described by a Markov model.
  
  
  RESULTS
  The ICER of adding HBV MP-6-NAT or HBV ID-NAT in the Netherlands is Euro303,218 (95% confidence interval [CI], Euro233,001-Euro408,388) and Euro518,995 (95% CI, Euro399,359-Euro699,120) per quality-adjusted life-year, respectively. The ICER strongly correlates with the age of transfusion recipients.
  
  
  CONCLUSIONS
  The cost-effectiveness of additional HBV NAT is limited by the limited loss of life caused by HBV transmission. Despite a higher effectiveness, HBV ID-NAT is less cost-effective than MP-6-NAT due to higher costs. A future equivalent participation of immigrants from HBV-endemic countries in the donor base renders HBV NAT only slightly more cost-effective.
authors.affiliation: University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, the Netherlands. b.borkent@umcutrecht.nl
authors.forename: B A
authors.initials: BA
authors.lastname: Borkent-Raven
authors.forename: M P
authors.initials: MP
authors.lastname: Janssen
authors.forename: C L
authors.initials: CL
authors.lastname: van der Poel
authors.forename: G A
authors.initials: GA
authors.lastname: de Wit
authors.forename: G J
authors.initials: GJ
authors.lastname: Bonsel
authors.forename: B A
authors.initials: BA
authors.lastname: van Hout
mesh_terms: D001782:Blood Donors; D001803:Blood Transfusion / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000191:economics; D004279:DNA, Viral / Q000097:blood*; D006509:Hepatitis B / Q000517:prevention & control / Q000635:transmission*; D006515:Hepatitis B virus / Q000235:genetics*; D006801:Humans; D015994:Incidence; D008390:Markov Chains; D018803:Models, Economic; D015233:Models, Statistical; D009426:Netherlands / Q000453:epidemiology; D021141:Nucleic Acid Amplification Techniques / Q000191:economics; D065227:Transfusion Reaction
chemical_list: D004279:DNA, Viral