title: Cost-Effectiveness Analysis of Different Testing Strategies that Use Antibody Levels to Detect Chronic Hepatitis C in Blood Donors.
abstract: We conducted a cost-effectiveness analysis of seven hepatitis C virus (HCV) testing strategies in blood donors.
  
  
  
  Three of the seven strategies were based on HCV diagnosis and reporting guidelines in Mexico and four were from previous and current recommendations outlined by the CDC. The strategies that were evaluated determine antibody levels according to the signal-to-cut-off (S/CO) ratio and use reflex Immunoblot (IMB) or HCV RNA tests to confirm true positive (TP) cases of chronic HCV infection. Costs were calculated from the perspective of the Mexican Institute of Social Security (IMSS). A decision tree model was developed to estimate the expected number of true positive cases and costs for the base-case scenarios and for the sensitivity analyses.
  
  
  
  Base-case findings indicate an extended dominance of the CDC-USA2 and CDC-USA4 options by the IMSS Mexico3 and IMSS-Mexico1 alternatives. The probabilistic sensitivity analyses results suggest that for a willingness-to-pay (WTP) range of $0-9,000 USD the IMSS-Mexico1 strategy is the most cost-effective of all strategies ($5,000 USD per TP). The IMSS-Mexico3, IMSS-Mexico2, and CDC-USA3 strategies are also cost-effective strategies that cost between $7,800 and $8,800 USD per TP case detected. The CDC-USA1 strategy was very expensive and not cost-effective.
  
  
  
  HCV antibody testing strategies based on the classification of two or three levels of the S/CO are cost-effective procedures to identify patients who require reflex IMB or HCV RNA testing to confirm chronic HCV infection.
authors.affiliation: Unidad de Investigación Epidemiológica y en Servicios de Salud Área Envejecimiento, Instituto Mexicano del Seguro Social, Ciudad de México, México.
authors.forename: Víctor
authors.initials: V
authors.lastname: Granados-García
authors.affiliation: Departamento de Salud Pública. Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara Jalisco, México.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Contreras
authors.affiliation: Dirección de Investigación, Instituto Nacional de Geriatría, Ciudad de México, México.
authors.forename: Carmen
authors.initials: C
authors.lastname: García-Peña
authors.affiliation: Centro de Estudios Económicos y Sociales en Salud, Hospital Infantil de México Federico Gómez, Ciudad de México, México.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Salinas-Escudero
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
authors.forename: Hla-Hla
authors.initials: HH
authors.lastname: Thein
authors.affiliation: Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca Morelos, México.|UCLA Department of Health Policy and Management, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, United States of America.
authors.forename: Yvonne N
authors.initials: YN
authors.lastname: Flores
mesh_terms: D001782:Blood Donors; D003362:Cost-Benefit Analysis; D018937:Hepatitis C Antibodies / Q000097:blood*; D019698:Hepatitis C, Chronic / Q000175:diagnosis*; D006801:Humans
chemical_list: D018937:Hepatitis C Antibodies