title: Cost effectiveness of adding nucleic acid testing to hepatitis B, hepatitis C, and human immunodeficiency virus screening of blood donations in Zimbabwe.
abstract: The aim of this study was to assess the cost effectiveness of introducing individual-donation nucleic acid testing (ID-NAT), in addition to serologic tests, compared with the exclusive use of serologic tests for the identification of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) I and II among blood donors in Zimbabwe.
  
  
  
  The costs, health consequences, and cost effectiveness of adding ID-NAT to serologic tests, compared with serologic testing alone, were estimated from a health care perspective using a decision-analytic model.
  
  
  
  The introduction of ID-NAT in addition to serologic tests would lower the risk of HBV, HCV, and HIV transmission to 46.9, 0.3, and 2.7 per 100,000 donations, respectively. ID-NAT would prevent an estimated 25, 6, and 9 HBV, HCV, and HIV transfusion-transmitted infections per 100,000 donations, respectively. The introduction of this intervention would result in an estimated 212 quality-adjusted life-years (QALYs) gained. The incremental cost-effectiveness ratio is estimated at US$17,774/QALY, a value far more than three times the gross national income per capita for Zimbabwe.
  
  
  
  Although the introduction of NAT could further improve the safety of the blood supply, current evidence suggests that it cannot be considered cost effective. Reducing the test costs for NAT through efficient donor recruitment, negotiating the price of reagents, and the efficient use of technology will improve cost effectiveness.
authors.affiliation: Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.|National Blood Service Zimbabwe, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Nyashadzaishe
authors.initials: N
authors.lastname: Mafirakureva
authors.affiliation: Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.|National Blood Service Zimbabwe, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Tonderai
authors.initials: T
authors.lastname: Mapako
authors.affiliation: Department of Clinical Pharmacology, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Star
authors.initials: S
authors.lastname: Khoza
authors.affiliation: National Blood Service Zimbabwe, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Jean C
authors.initials: JC
authors.lastname: Emmanuel
authors.affiliation: National Blood Service Zimbabwe, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Lucy
authors.initials: L
authors.lastname: Marowa
authors.affiliation: National Blood Service Zimbabwe, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: David
authors.initials: D
authors.lastname: Mvere
authors.affiliation: Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.|Institute of Science in Healthy Aging & Healthcare (SHARE), University Medical Center Groningen.
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Postma
authors.affiliation: Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.|Department of Clinical Pharmacy and Toxicology, Martini Hospital, Groningen, The Netherlands.
authors.forename: Marinus
authors.initials: M
authors.lastname: van Hulst
mesh_terms: D001782:Blood Donors; D058731:Blood Safety / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission; D016174:Hepacivirus / Q000302:isolation & purification*; D006509:Hepatitis B / Q000517:prevention & control / Q000635:transmission; D006515:Hepatitis B virus / Q000302:isolation & purification*; D006526:Hepatitis C / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D021141:Nucleic Acid Amplification Techniques / Q000191:economics / Q000379:methods; D012698:Serologic Tests / Q000191:economics / Q000379:methods; D015030:Zimbabwe