title: Cost-effectiveness of prion filtration of red blood cells to reduce the risk of transfusion-transmitted variant Creutzfeldt-Jakob disease in the Republic of Ireland.
abstract: BACKGROUND
  Variant Creutzfeldt-Jakob disease (vCJD) is a rare, progressive fatal noninflammatory neurodegenerative disease. Ireland has the second highest rate of vCJD in the world with an ongoing risk of vCJD transmission through blood transfusion. Prion-removing filters have been developed to reduce the risk of vCJD transmission. This study aimed to evaluate the cost-effectiveness of implementing a policy of prion filtration of red blood cells (RBCs) in the Republic of Ireland.
  
  
  METHODS
  A cost-effectiveness model was developed to simulate the likelihood of RBC recipients developing clinical vCJD as a result of being transfused with infected RBCs. Model variables were collected from published literature and expert opinion. Costs were estimated based on the processing changes required to implement prion filtration.
  
  
  RESULTS
  In the absence of prion filtration, it is estimated that two individuals will develop clinical vCJD arising from RBC transfusions over a 10-year time horizon. The discounted life-years lost will be 18.5 years. With prion filtration, there will be no deaths or life-years lost. The discounted cost of universal prion filtration is €68.2 million over 10 years with a corresponding incremental cost-effectiveness ratio of €3.7 million per life-year gained. In 25.3% of simulations there were no deaths from vCJD infection through infected blood transfusions, irrespective of prion filtration.
  
  
  CONCLUSIONS
  Prion filtration is considered not cost-effective by traditional measures. Although numerous non-cost-effective blood safety strategies have been implemented in the past, consideration should be given to the most efficient use of finite resources in transfusion medicine.
authors.affiliation: Health Information and Quality Authority, Dublin, Ireland. cteljeur@hiqa.ie
authors.forename: Conor
authors.initials: C
authors.lastname: Teljeur
authors.forename: Martin
authors.initials: M
authors.lastname: Flattery
authors.forename: Patricia
authors.initials: P
authors.lastname: Harrington
authors.forename: Michelle
authors.initials: M
authors.lastname: O'Neill
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Moran
authors.forename: Linda
authors.initials: L
authors.lastname: Murphy
authors.forename: Máirín
authors.initials: M
authors.lastname: Ryan
mesh_terms: D058731:Blood Safety / Q000191:economics* / Q000295:instrumentation; D001803:Blood Transfusion / Q000191:economics*; D003362:Cost-Benefit Analysis; D007562:Creutzfeldt-Jakob Syndrome / Q000401:mortality* / Q000517:prevention & control* / Q000635:transmission; D005374:Filtration / Q000191:economics; D006291:Health Policy / Q000191:economics; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D017059:Models, Econometric; D015995:Prevalence; D011328:Prions / Q000097:blood*; D012307:Risk Factors; D065227:Transfusion Reaction
chemical_list: D011328:Prions