Risk assessment and cost-effectiveness/utility analysis

Busch, Michael P.; Walderhaug, Mark; Custer, Brian; Allain, Jean‐Pierre; Reddy, Ravi Shankar; McDonough, Brian

doi:10.1016/j.biologicals.2009.01.007

Cited by 19 publications

(12 citation statements)

References 28 publications

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“…The apparently marginal benefit of MP NAT, the high cost of ID NAT testing and its very low qualityadjusted-life-year benefit estimate have raised questions about the cost-effectiveness of HBV NAT implementation in low prevalence countries [43,45]. These arguments do not apply in countries with higher HBV prevalence [8,46]. It is unlikely that HBV NAT will replace current serological testing studies since up to 15% of HBsAg-confirmed-positive anti-HBc-positive donations test negative for HBV DNA even by ID-NAT [10,19,47].…”

Section: Hbv Nucleic Acid Testing (Nat)mentioning

confidence: 97%

Transfusion-transmitted hepatitis B virus infection

Candotti

Allain

2009

Journal of Hepatology

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191

158

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Hepatitis B virus (HBV) remains a major risk of transfusion-transmitted infection due to the pre-seroconversion window period (WP), infection with immunovariant viruses, and with occult carriage of HBV infection (OBI). Reduction of HBV residual risk depends upon developing more sensitive HBV surface antigen (HBsAg) tests, adopting anti-HBc screening when appropriate, and implementing HBV nucleic acid testing (NAT), either in minipools or more efficiently in individual samples. HBV NAT combines the ability to significantly reduce the window period and to detect occult HBV carriage substantiating decades of clinical observation that HBsAg-negative/anti-HBc-positive blood could transmit HBV. Clinical observations suggest limited transmission rate of occult HBV compared to WP. Low transmission rate might be related to low viral load observed in OBIs or to the presence of mutants associated with occult carriage. OBIs carrying detectable anti-HBs ( approximately 50%) are essentially not infectious by transfusion. However, recent data suggest that the neutralizing capacity of low anti-HBs may be inefficient when overcome by exposure to high viral load. Anti-HBc blood units without detectable anti-HBs appear moderately infectious except in immunocompromised recipients. Immunodeficient elderly and patients receiving immunosuppressive treatments may be susceptible to infection with lower infectious dose even in the presence of anti-HBs. The immune status of blood recipients should be taken into consideration when investigating "post-transfusion" HBV infection. Pre-transfusion testing and post-transfusion long-term follow-up of recipients, and molecular analysis of the virus infecting both donor and recipient are critical to definitively incriminate transfusion in the transmission of HBV.

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Section: Hbv Nucleic Acid Testing (Nat)mentioning

confidence: 97%

Transfusion-transmitted hepatitis B virus infection

Candotti

Allain

2009

Journal of Hepatology

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191

158

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“…There are already programmes estimating the cost-effectiveness of blood safety interventions [29], and a working party of the International Society of Blood Transfusion is dedicated to assessing different approaches to blood transfusion in developing countries [30]. On the basis of current evidence, it is suggested that leading funding organisations should focus on achieving adequate blood supply in order to save lives in the context of emergency blood transfusion in sub-Saharan Africa.…”

Section: Summary and Proposalsmentioning

confidence: 99%

External Financial Aid to Blood Transfusion Services in Sub-Saharan Africa: A Need for Reflection

Ala¹,

Allain

Bates

et al. 2012

PLoS Med

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“…The differential testing scheme discussed in this paper differs from the current policies described for Sub-Saharan Africa (see, e.g., Busch et al, 2009), where around 70-80% of the blood is collected from replacement donors, directly at the point of use in emergency situations (Lackritz et al, 1992). This method is inexpensive, as it does not involve donor recruitment expenses, the capital investment and infrastructure that the dedicated blood centers require (Owusu-Ofori et al, 2010), nor testing costs, as usually not even the basic HIV, HBV, and HCV tests are performed (Lara et al, 2007).…”

Section: Differential Versus Current Same-for-all Testing Schemesmentioning

confidence: 99%

“…As a result, resource allocation problems in healthcare have received significant attention in the medical literature and OR literature; see, e.g., Brandeau (2004), for an excellent review and references. Many studies examine the relationship between screening and risk reduction for a certain disease through the use of cost-effectiveness analysis (Leiby, 2001;Sendi et al, 2003;Busch et al, 2009), Markov processes (Schwartz et al, 1990;Jackson et al, 2003;Van Hulst et al, 2009), simulation models (Lefrere et al, 1998;Custer et al, 2005), decision trees (Marshall et al, 2004), or empirical studies (Lander et al, 2009). These methodologies usually compare a small number of specific interventions and rely on quite restrictive assumptions, including that the interventions are perfectly divisible, have constant returns to scale, and are independent (Sendi et al, 2003;Brandeau, 2004;Van Hulst et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Going beyond “same-for-all” testing of infectious agents in donated blood

Bish¹,

Bish²,

Xie³

et al. 2014

IIE Transactions

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Blood products, derived from donated blood, are essential for many medical treatments, and their safety, in terms of being free of Transfusion-Transmitted Infections (TTIs)-i.e., infectious agents that can be spread through their use-is crucial. However, blood screening tests are not perfectly reliable and may produce false negative or false-positive results. Currently, blood donations are tested using a same-for-all testing scheme, where a single test set is used on all blood donations. This article studies differential testing schemes, which may involve multiple test sets, each applied to a randomly selected fraction of the donated blood. Thus, although each blood donation is still tested by a single test set, multiple test sets may be used by the Blood Center. This problem is modeled within an optimization framework and a novel solution methodology is provided that allows important structural properties of such testing schemes to be characterized. It is shown that an optimal differential testing scheme consists of at most two test sets, and such a dual-test scheme can significantly reduce the TTI risk over the current same-for-all testing. The presented analysis leads to an efficient greedy algorithm that generates the optimal differential test sets for a range of budgets to inform the decision-maker (e.g., Blood Center). The differential model is extended to the case where different test sets can be used on sub-sets of donations defined by donation characteristics (e.g., donor demographics, seasonality, or region) that differentiate the sub-set's TTI prevalence rates. The risk reduction potential of differential testing is quantified through two case studies that use published data from Sub-Saharan Africa and the United States. The study generates key insight into public policy decision making on the design of blood screening schemes.

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Risk assessment and cost-effectiveness/utility analysis

Cited by 19 publications

References 28 publications

Transfusion-transmitted hepatitis B virus infection

Transfusion-transmitted hepatitis B virus infection

External Financial Aid to Blood Transfusion Services in Sub-Saharan Africa: A Need for Reflection

Going beyond “same-for-all” testing of infectious agents in donated blood

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