Cost‐effectiveness and budget impact of whole blood pathogen reduction in Ghana

Abstract

Background: Despite the promise of pathogen reduction for reducing transfusion-associated adverse events in sub-Saharan Africa, no healtheconomic assessment is publicly available.Study Design and Methods: We developed a mathematical risk reduction model to estimate the impact of nationwide whole blood pathogen reduction in Ghana on the incidence of six infectious and one non-infectious transfusion-associated adverse events. We estimated the lifetime direct healthcare costs and disability-adjusted life years lost for each adverse event.For HIV, HCV, and HBV, we simulated disease progression using Markov models, accounting for the likelihood and timing of clinical detection and treatment. We performed probabilistic and univariate sensitivity analysis.Results: Adding whole blood pathogen reduction to Ghana's blood safety portfolio would avert an estimated 19,898 (11,948-27,353) adverse events and 38,491 (16,444-67,118) disability-adjusted life years annually, primarily by averting sepsis (49%) and malaria (31%) infections.

Ignored and undervalued in public health: a systematic review of health state utility values associated with syphilis infection

“…Of these, 36 studies were included in our review. In total, 22 economic evaluations were included [ 21 – 40 ]; fifteen had the outcome framed in DALYs [ 21 – 34 , 41 ], and seven had the outcome framed in QALYs [ 35 – 40 , 42 ]. Two primary studies were identified after hand-searching reference lists [ 40 , 43 ].…”

“…Supplementary Table S 11 summarises the key characteristics of the 36 studies reviewed. For the 22 economic evaluations, two studies were from low-income countries [ 21 , 27 ], three from lower-middle-income countries [ 32 , 33 , 41 ], three from upper-middle-income countries [ 22 , 29 , 31 ], eight from high-income countries [ 23 , 35 – 40 , 42 ], and six from a mixture of countries [ 24 – 26 , 28 , 30 , 34 ]. Fifteen studies (68%) reported the cost-effectiveness of antenatal screening for syphilis [ 21 , 22 , 24 – 34 , 36 , 37 ].…”

“…Fifteen studies (68%) reported the cost-effectiveness of antenatal screening for syphilis [ 21 , 22 , 24 – 34 , 36 , 37 ]. In addition to studies reporting weights for mothers and their newborns, other common populations included blood donors and patients receiving blood transfusions [ 23 , 41 , 42 ], and people living with HIV [ 35 , 39 ].…”

“…Table 2 summarises the disability weights and associated durations used in the 15 economic evaluations in which the primary outcome was framed in DALYs [ 21 – 34 , 41 ]. The commonly used health states for newborns were congenital syphilis ( n =13) with disability weight ranges from 0·315 to 0·316, low birth weight ( n =9) with ranges from 0·106 to 0·291, and miscarriage ( n =3), stillbirth ( n =13), and neonatal death ( n =12) all with values of 0 or 1.…”

“…Three studies referenced other economic evaluations in our review for their disability weights [ 27 , 30 , 34 ]. The only economic evaluation that did not use GBD weights assumed the health state utility value, giving a disability weight of 0·12 for syphilis [ 41 ].…”