Health and economic impact of posttransfusion hepatitis B and cost-effectiveness analysis of expanded HBV testing protocols of blood donors: a study focused on the European Union.

Abstract

BACKGROUND:

Residual risk of posttransfusion hepatitis B (PT-HB) may be reduced through implementation of HBV NAT or the new, enhanced-sensitivity HBsAg assays in routine donor testing. However, there are some doubts about the cost-effectiveness of these new safety measures, because hepatitis B acquired in adulthood is not regarded as a severe disease in western countries.

STUDY DESIGN AND METHODS:

A computer model was designed to estimate the health outcomes and associated costs of patients with PT-HB. Results from this model and estimations of the residual risk of HBV transmission, the risk reduction yielded by the new assays, and their cost were used to calculate the cost-effectiveness of including the new HBsAg assays or single-sample HBV NAT in the routine screening of blood donors.

RESULTS:

The model predicts that 0.97 percent of patients with PT-HB die of liver disease (54% of them due to fulminant hepatitis). The mean loss of life expectancy was 0.178 years per patient, and the present value of the lifetime costs of treating PT-HB was 4160 euros per patient. Single-donor HBV NAT or the new HBsAg assays would increase the life expectancy of blood recipients by 16 (95% CI, 8-40) or 14 (95% CI, 7-28) years, respectively, per every 10 million donations tested. The projected cost per life-year gained was 0.79 (95% CI, 0.15-1.85) million euros for the enhanced-sensitivity HBsAg assays and 5.8 (95% CI, 1.9-13.1) million euros for single-donation HBV NAT, both compared with current HBsAg assays. If single-donation HBV NAT is compared with the new HBsAg assays, its cost- effectiveness ratio increases to 53 (95% CI, 16-127) million euros.

CONCLUSION:

PT-HB has few health or economic repercussions. Single-donation HBV NAT would provide a small health benefit at a very high cost. Instead, in some circumstances, the cost-effectiveness of enhanced-sensitivity HBsAg assays would be within acceptable ranges for new public health interventions.

• Authors: Arturo Pereira
• Journal: Transfusion (Transfusion) Vol. 43 Issue 2 Pg. 192-201 (Feb 2003) ISSN: 0041-1132 [Print] United States
• PMID: 12559015 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Viral
• DNA, Viral

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antibodies, Viral (blood)
• Blood Donors
• Blood Transfusion (economics)
• Child
• Child, Preschool
• Cost-Benefit Analysis
• DNA, Viral (blood)
• European Union
• Hepatitis B (diagnosis, economics, transmission)
• Humans
• Infant
• Infant, Newborn
• Mass Screening (economics, methods)
• Middle Aged
• Models, Economic
• Quality-Adjusted Life Years
• Transfusion Reaction