The cost-effectiveness of introducing nucleic acid testing to test for hepatitis B, hepatitis C, and human immunodeficiency virus among blood donors in Sweden.
BACKGROUND
The purpose of this study was to estimate the cost-effectiveness of using individual-donor nucleic acid testing (ID-NAT) in addition to serologic tests compared with the sole use of serologic tests for the identification of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) among blood donors in Sweden.


METHODS
The two strategies analyzed were serologic tests and ID-NAT plus serologic tests. A health-economic model was used to estimate the lifetime costs and effects. The effects were measured as infections avoided and quality-adjusted life-years (QALYs) gained. A societal perspective was used.


RESULTS
The largest number of viral transmissions occurred with serologic testing only. However, the risks for viral transmissions were very low with both strategies. The total cost was mainly influenced by the cost of the test carried out. The cost of using ID-NAT plus serologic tests compared to serologic tests alone was estimated at Swedish Krona (SEK) 101 million (USD 12.7 million) per avoided viral transmission. The cost per QALY gained was SEK 22 million (USD 2.7 million).


CONCLUSIONS
Using ID-NAT for testing against HBV, HCV, and HIV among blood donors leads to cost-effectiveness ratios that are far beyond what is usually considered cost-effective. The main reason for this is that with current methods, the risks for virus transmission are very low in Sweden.
Davidson
Thomas
T
Center for Medical Technology Assessment, Department of Clinical and Experimental Medicine, Linköping University, Sweden. Thomas.Davidson@liu.se
Ekermo
Bengt
B
Gaines
Hans
H
Lesko
Birgitta
B
Åkerlind
Britt
B
D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D001782:Blood Donors; D058731:Blood Safety / Q000191:economics* / Q000379:methods; D001803:Blood Transfusion / Q000191:economics; D003362:Cost-Benefit Analysis; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D006678:HIV / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D015658:HIV Infections / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D006509:Hepatitis B / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D006526:Hepatitis C / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D021141:Nucleic Acid Amplification Techniques / Q000191:economics*; D011247:Pregnancy; D019057:Quality-Adjusted Life Years; D012367:RNA, Viral / Q000097:blood*; D012698:Serologic Tests / Q000191:economics; D013548:Sweden / Q000453:epidemiology
D000914:Antibodies, Viral; D004279:DNA, Viral; D012367:RNA, Viral