title: Cost-effectiveness of blood donor screening for Babesia microti in endemic regions of the United States.
abstract: BACKGROUND
  Babesia microti is the leading reported cause of red blood cell (RBC) transfusion-transmitted infection in the United States. Donor screening assays are in development.
  
  
  METHODS
  A decision analytic model estimated the cost-effectiveness of screening strategies for preventing transfusion-transmitted babesiosis (TTB) in a hypothetical cohort of transfusion recipients in Babesia-endemic areas of the United States. Strategies included: 1) no screening; 2) Uniform Donor Health History Questionnaire (UDHQ), "status quo"; 3) recipient risk targeting using donor antibody and polymerase chain reaction (PCR) screening; 4) universal endemic donor antibody screening; and 5) universal endemic donor antibody and PCR screening. Outcome measures were TTB cases averted, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs; $/QALY). We assumed a societal willingness to pay of $1 million/QALY based on screening for other transfusion-transmitted infections.
  
  
  RESULTS
  Compared to no screening, the UDHQ avoids 0.02 TTB cases per 100,000 RBC transfusions at an ICER of $160,000/QALY whereas recipient risk-targeted strategy using antibody/PCR avoids 1.62 TTB cases per 100,000 RBC transfusions at an ICER of $713,000/QALY compared to the UDHQ. Universal endemic antibody screening avoids 3.39 cases at an ICER of $760,000/QALY compared to the recipient risk-targeted strategy. Universal endemic antibody/PCR screening avoids 3.60 cases and has an ICER of $8.8 million/QALY compared to universal endemic antibody screening. Results are sensitive to blood donor Babesia prevalence, TTB transmission probability, screening test costs, risk and severity of TTB complications, and impact of babesiosis diagnosis on donor quality of life.
  
  
  CONCLUSIONS
  Antibody screening for Babesia in endemic regions is appropriate from an economic perspective based on the societal willingness to pay for preventing infectious threats to blood safety.
authors.affiliation: Department of Public Health, Weill Cornell Medical College, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Simon
authors.forename: Jared A
authors.initials: JA
authors.lastname: Leff
authors.forename: Ankur
authors.initials: A
authors.lastname: Pandya
authors.forename: Melissa
authors.initials: M
authors.lastname: Cushing
authors.forename: Beth H
authors.initials: BH
authors.lastname: Shaz
authors.forename: David P
authors.initials: DP
authors.lastname: Calfee
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Schackman
authors.forename: Alvin I
authors.initials: AI
authors.lastname: Mushlin
mesh_terms: D041001:Babesia microti / Q000472:pathogenicity*; D001404:Babesiosis / Q000453:epidemiology* / Q000517:prevention & control; D001782:Blood Donors / Q000706:statistics & numerical data*; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D019353:Endemic Diseases / Q000517:prevention & control; D006801:Humans; D014481:United States / Q000453:epidemiology