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The Cost-Effectiveness of Screening the U.S. Blood Supply for West Nile Virus

Brian Custer, PhD; Michael P. Busch, MD, PhD; Anthony A. Marfin, MD, MPH; and Lyle R. Petersen, MD, MPH
[+] Article and Author Information

From the Blood Systems Research Institute, University of California, San Francisco, and Centers for Disease Control and Prevention, San Francisco, California; and National Center for Infectious Diseases, Fort Collins, Colorado.


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, bcuster@bloodsystems.org.

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.


Ann Intern Med. 2005;143(7):486-492. doi:10.7326/0003-4819-143-7-200510040-00007
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Cost-effectiveness was determined by using a Markov cohort simulation model (Appendix Figure) designed to assess safety interventions for donated blood (2, 1417). Each patient in the cohort receives 1 unit of whole blood or an equivalent amount of component (erythrocytes, platelets, or fresh-frozen plasma) from a single donor. We assumed that each donated unit of blood is processed into 1.45 units of transfused components (18) and that each transfusion occurs in patients who are 60 years of age and carries the independent risk of a transfusion-transmitted infection. The core structure of the model and values for all variables are provided in the Appendix.

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Figures

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Figure 1.
Incremental costs versus incremental effects from probabilistic sensitivity analysis for each strategy relative to no screening.

During probabilistic sensitivity analysis, 1000 incremental effectiveness and incremental cost results were calculated for each West Nile virus testing strategy. Each point on the graph represents the cost-effectiveness result for 1 iteration for the corresponding strategy. 1/2 MP = half-year minipool testing; 1 MP = year-round minipool testing; 1/12 ID + 11/12 MP = 1/12 individual donation testing with 11/12 minipool testing; 1/4 ID + 3/4 MP = 1/4 individual donation testing with 3/4 minipool testing; 1/3 ID + 2/3 MP = 1/3 individual donation testing with 2/3 minipool testing; 1 ID = year-round individual donation testing.

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Figure 2.
Cost-effectiveness acceptability curves demonstrating the probability that a strategy is cost effective at the willingness to pay value listed.

Values on the x-axis are the cost-effectiveness thresholds. 1/2 MP = half-year minipool testing; 1 MP = year-round minipool testing; 1/12 ID + 11/12 MP = 1/12 individual donation testing with 11/12 minipool testing; 1/4 ID + 3/4 MP = 1/4 individual donation testing with 3/4 minipool testing; 1/3 ID + 2/3 MP = 1/3 individual donation testing with 2/3 minipool testing; 1 ID = year-round individual donation testing; QALY = quality-adjusted life-year.

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Figure 3.
Cost-effectiveness of each screening strategy as a function of the residual risk of West Nile virus in blood components with no screening.

The 2 vertical lines represent the approximate residual risk that would have been observed if testing had not been in place in 2003 and 2004. 1/2 MP = half-year minipool testing; 1 MP = year-round minipool testing; 1/12 ID + 11/12 MP = 1/12 individual donation testing with 11/12 minipool testing; 1/4 ID + 3/4 MP = 1/4 individual donation testing with 3/4 minipool testing; 1/3 ID + 2/3 MP = 1/3 individual donation testing with 2/3 minipool testing; 1 ID = year-round individual donation testing.

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Appendix Figure.
Core structure of the West Nile virus (WNV) cost-effectiveness model displayed using a decision tree format for the no-testing strategy.

Nodes marked with an “M” represent Markov process chance nodes. NAT = nucleic acid testing.

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Summary for Patients

The Cost-Effectiveness of Screening the U.S. Blood Supply for West Nile Virus

The summary below is from the full report titled “The Cost-Effectiveness of Screening the U.S. Blood Supply for West Nile Virus.” It is in the 4 October 2005 issue of Annals of Internal Medicine (volume 143, pages 486-492). The authors are B. Custer, M.P. Busch, A.A. Marfin, and L.R. Petersen.

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