The cost-effectiveness of NAT for HIV, HCV, and HBV in whole-blood donations
The cost-effectiveness of NAT for HIV, HCV, and HBV in whole-blood donations
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DOI：
10.1046/j.1537-2995.2003.00392.x
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发表时间：
2003-06-01
期刊：
影响因子：
2.9
通讯作者：
AuBuchon, JP
中科院分区：
文献类型：
--
作者：
Jackson, BR;Busch, MP;AuBuchon, JP
背景技术背景：由于积极的筛查和检测实践，与输血相关的病毒感染风险比以往任何时候都低。NAT技术已经降低了风险，甚至进一步，但在额外的成本health-care system.Study设计和方法：边际成本效益NAT的HIV，HCV和HBV的全血捐赠与先前发表的马尔可夫决策模型计算。该模型使用2001年美国红十字会所有全血捐献的发病率数据以及逆转录病毒流行病学捐献者研究（REDS）的窗口期数据进行更新。用于HIV和HCV的全血捐赠NAT预计将花费1.55亿美元在美国，每年的小型捐赠NAT（minipool NAT）和4.28亿美元（单次捐赠NAT）可以避免4至7例HIV感染和56至59例HCV感染。增加HBV NAT预计将避免9至37例HBV感染，每年的额外费用在3900万至1.3亿美元之间。总体而言，NAT每挽救一个质量调整生命年将花费470万至1120万美元。停止HIV p24抗原和HBc检测会抵消这一点。结论：全血NAT的成本效益差。测试成本需要大幅降低，以使成本效益与大多数其他公认的医疗做法一致。
BACKGROUND: The risk of viral infection associated with blood transfusion is lower than ever before because of aggressive screening and testing practices. NAT technology has lowered that risk even further but at an additional cost to the health-care system.STUDY DESIGN AND METHODS: Marginal cost-effectiveness of NAT for HIV, HCV, and HBV in whole-blood donations was calculated with a previously published Markov decision model. This model was updated with disease incidence data from all 2001 American Red Cross whole-blood donations as well as window-period data from the Retrovirus Epidemiology Donor Study (REDS).RESULTS: Whole-blood donation NAT for HIV and HCV is expected to cost between $155 million (minipool NAT) and $428 million (single-donation NAT) per year in the US and avert 4 to 7 HIV infections and 56 to 59 HCV infections. Adding HBV NAT would be expected to avert 9 to 37 HBV infections at an additional cost of between $39 million and $130 million per year. Overall, NAT would cost between $4.7 million and $11.2 million per quality-adjusted life-year saved. Discontinuing HIV p24 antigen and HBc testing would offset this somewhat.CONCLUSIONS: The cost-effectiveness of whole-blood NAT is poor. The testing cost would need to decrease significantly to bring the cost-effectiveness in line with most other accepted medical practices.