BACKGROUND: Trypanosoma cruzi, the etiologic agent of Chagas disease, is a potential threat to transfusion recipients in the United States. The cost-effectiveness of seven testing strategies was evaluated against no testing and hierarchically in incremental analysis. Donor-specific strategies included testing donors born in endemic countries, testing all donors a specific number of times, or testing all donors every time. Component-specific strategies are based on screening platelet-containing donations. STUDY DESIGN AND METHODS: A decision analytic model simulated the lifetime cost (US dollars) and health outcomes (quality-adjusted life-years [QALYs]) of two hypothetical cohorts of blood recipients, an all-ages and a younger subset, from a 2007 societal perspective. Model variable values were obtained from US screening data, Blood Systems Laboratory, the Health Care Utilization Project, and published literature. RESULTS: For the all-ages cohort, compared to no testing, the cost-effectiveness of testing all donors one time was $757,000 per QALY, all donors two times $970,000 per QALY, and universal testing $1.36 million per QALY. In the all-ages and the younger transfused populations, testing donors with geographical exposure was most cost-effective ($173,000 and $29,000/QALY, respectively). The most influential variables in the model were related to characteristics of the transfused population: survival and health state utilities. With respect to T. cruzi variables, results were most sensitive to seroprevalence and transmissibility. CONCLUSION: Selective T. cruzi screening generates nearly the same effectiveness as universal screening, but at a reduced cost. Outcomes and associated costs of Chagas disease take longer to materialize than the average life expectancy of transfusion recipients.
BACKGROUND:Trypanosoma cruzi, the etiologic agent of Chagas disease, is a potential threat to transfusion recipients in the United States. The cost-effectiveness of seven testing strategies was evaluated against no testing and hierarchically in incremental analysis. Donor-specific strategies included testing donors born in endemic countries, testing all donors a specific number of times, or testing all donors every time. Component-specific strategies are based on screening platelet-containing donations. STUDY DESIGN AND METHODS: A decision analytic model simulated the lifetime cost (US dollars) and health outcomes (quality-adjusted life-years [QALYs]) of two hypothetical cohorts of blood recipients, an all-ages and a younger subset, from a 2007 societal perspective. Model variable values were obtained from US screening data, Blood Systems Laboratory, the Health Care Utilization Project, and published literature. RESULTS: For the all-ages cohort, compared to no testing, the cost-effectiveness of testing all donors one time was $757,000 per QALY, all donors two times $970,000 per QALY, and universal testing $1.36 million per QALY. In the all-ages and the younger transfused populations, testing donors with geographical exposure was most cost-effective ($173,000 and $29,000/QALY, respectively). The most influential variables in the model were related to characteristics of the transfused population: survival and health state utilities. With respect to T. cruzi variables, results were most sensitive to seroprevalence and transmissibility. CONCLUSION: Selective T. cruzi screening generates nearly the same effectiveness as universal screening, but at a reduced cost. Outcomes and associated costs of Chagas disease take longer to materialize than the average life expectancy of transfusion recipients.
Authors: Andrea Angheben; Lucia Boix; Dora Buonfrate; Federico Gobbi; Zeno Bisoffi; Simonetta Pupella; Giorgio Gandini; Giuseppe Aprili Journal: Blood Transfus Date: 2015-10 Impact factor: 3.443
Authors: Claudia R De Marchi; Javier M Di Noia; Alberto C C Frasch; Vicente Amato Neto; Igor C Almeida; Carlos A Buscaglia Journal: Clin Vaccine Immunol Date: 2011-08-31
Authors: Matthew S Simon; Jared A Leff; Ankur Pandya; Melissa Cushing; Beth H Shaz; David P Calfee; Bruce R Schackman; Alvin I Mushlin Journal: Transfusion Date: 2013-11-19 Impact factor: 3.157
Authors: Gabrielle C Hunter; Katty Borrini-Mayorí; Jenny Ancca Juárez; Ricardo Castillo Neyra; Manuela R Verastegui; Fernando S Malaga Chavez; Juan Geny Cornejo del Carpio; Eleazar Córdova Benzaquen; César Náquira; Robert H Gilman; Caryn Bern; Michael Z Levy Journal: PLoS Negl Trop Dis Date: 2012-01-10
Authors: Clemens Scott Kruse; David A Guerra; Raena Gelillo-Smith; Amber Vargas; Laavanya Krishnan; Paula Stigler-Granados Journal: Am J Trop Med Hyg Date: 2019-11 Impact factor: 2.345