Brian Custer, PhD; Michael P. Busch, MD, PhD; Anthony A. Marfin, MD, MPH; Lyle R. Petersen, MD, MPH
Grant Support: By an unrestricted grant from Blood Systems Foundation.
Potential Financial Conflicts of Interest: Employment: B. Custer (Blood Systems, Inc.), M.P. Busch (Blood Systems, Inc.); Consultancies: M.P. Busch (Chiron Corp., Roche, Gen-Probe); Grants received: B. Custer (Blood Systems Foundation), M.P. Busch (Chiron Corp., National Institutes of Health, Centers for Disease Control and Prevention).
Requests for Single Reprints: Brian Custer, PhD, Blood Systems Research Institute, 270 Masonic Avenue, San Francisco, CA 94118-4417; e-mail, email@example.com.
Current Author Addresses: Dr. Custer: Blood Systems Research Institute, 270 Masonic Avenue, San Francisco, CA 94118-4417.
Dr. Busch: Department of Laboratory Medicine, University of California, San Francisco, c/o Blood Systems Research Institute, 270 Masonic Avenue, San Francisco, CA 94118-4417.
Dr. Marfin: San Francisco International Airport, Quarantine Station, Centers for Disease Control and Prevention, U.S. Public Health Service, Department of Health and Human Services, San Francisco, CA 94128-0548.
Dr. Petersen: Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, U.S. Public Health Service, Department of Health and Human Services, Fort Collins, CO 80522-2087.
Author Contributions: Conception and design: B. Custer, M.P. Busch, A.A. Marfin, L.R. Petersen.
Analysis and interpretation of the data: B. Custer, M.P. Busch, A.A. Marfin, L.R. Petersen.
Drafting of the article: B. Custer, A.A. Marfin, L.R. Petersen.
Critical revision of the article for important intellectual content: B. Custer, M.P. Busch, A.A. Marfin, L.R. Petersen.
Final approval of the article: B. Custer, M.P. Busch, A.A. Marfin, L.R. Petersen.
Provision of study materials or patients: M.P. Busch.
Statistical expertise: B. Custer.
Obtaining of funding: B. Custer, M.P. Busch.
Administrative, technical, and logistic support: B. Custer.
Collection and assembly of data: B. Custer, M.P. Busch.
The spread of West Nile virus across North America and evidence of transmission by transfusion prompted the U.S. Food and Drug Administration to encourage the development of methods to screen the blood supply.
To assess the cost-effectiveness of nucleic acid amplification testing for West Nile virus in the U.S. blood supply.
Markov cohort simulation.
Outcome probabilities estimated from nucleic acid testing done for West Nile virus in 2003, data from the Centers for Disease Control and Prevention, and published literature. Costs were taken from an economic study of West Nile virus infection and from estimated test costs.
Transfusion recipients, 60 years of age or older, with and without underlying immunocompromise.
The authors compared 6 strategies, taking into consideration minipool (pools of 6 to 16 donations) versus individual donation testing, and the geographic and seasonal nature of West Nile virus activity.
Costs and effects of each strategy based on the prevention of transfusion-transmitted West Nile virus.
The cost-effectiveness of annual, national minipool testing was $483 000 per quality-adjusted life-year (QALY), whereas the cost-effectiveness of annual, national individual donation testing was $897 000/QALY. The cost-effectiveness of targeted individual donation testing in an area experiencing an outbreak coupled with minipool testing elsewhere was $520 000/QALY.
In 1-way analyses, the most important influences were the prevalence of West Nile virus and the cost of minipool testing and individual donation testing. The 95% range of results from probabilistic sensitivity analysis for targeted individual donation testing was $256 000 to $1 044 000/QALY.
The outcomes of West Nile virus infection were based on data from the general population rather than from the population who received transfusions. The results are most useful in the context of geographically focused outbreaks of West Nile virus infection.
Using targeted individual donation testing to interdict blood donations that are positive for the West Nile virus is relatively cost-effective but is highly dependent on West Nile virus prevalence.
Brian Custer, Michael P. Busch, Anthony A. Marfin, Lyle R. Petersen. The Cost-Effectiveness of Screening the U.S. Blood Supply for West Nile Virus. Ann Intern Med. 2005;143:486–492. doi: 10.7326/0003-4819-143-7-200510040-00007
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Published: Ann Intern Med. 2005;143(7):486-492.
CNS Infections, Healthcare Delivery and Policy, Infectious Disease, Neurology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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