Marshall D A, Kleinman S H, Wong J B, AuBuchon J P, Grima D T, Kulin N A, Weinstein M C
Innovus Research Inc., Burlington, Canada.
Vox Sang. 2004 Jan;86(1):28-40. doi: 10.1111/j.0042-9007.2004.00379.x.
The aim of this study was to examine the cost-effectiveness of adding nucleic acid testing (NAT) to serological (antibody and antigen) screening protocols for donated blood in the United States (US) with the purpose of reducing the risks of transfusion-transmission of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV).
The costs, health consequences and cost-effectiveness of adding either minipool or individual-donor NAT to serological screening (SS) testing were estimated using a decision-analysis model.
With the given modelling assumptions, adding minipool NAT would avoid an estimated 37, 128 and eight cases of HBV, HCV and HIV, respectively, and save approximately 53 additional years of life and 102 additional quality adjusted life years (QALYs) compared with SS, at a net cost of $154 million. SS + minipool NAT - p24 compared with SS alone resulted in an incremental cost-effectiveness ratio of $1.5 million per QALY gained (range in sensitivity analysis $1.0-2.1 million per QALY gained) in this US analysis.
The cost effectiveness of adding NAT screening is outside the typical range for most healthcare interventions, but not for established blood safety measures.
本研究旨在探讨在美国，将核酸检测（NAT）添加到献血的血清学（抗体和抗原）筛查方案中的成本效益，以降低乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）和人类免疫缺陷病毒（HIV）输血传播风险。
使用决策分析模型估算了将混合样本或单个供者NAT添加到血清学筛查（SS）检测中的成本、健康后果及成本效益。
在给定的建模假设下，与血清学筛查相比，添加混合样本NAT分别可避免估计37例、128例和8例HBV、HCV和HIV感染，节省约53个生命年和102个质量调整生命年（QALY），净成本为1.54亿美元。在美国的这项分析中，与单独的血清学筛查相比，血清学筛查加混合样本NAT - p24检测每获得一个QALY的增量成本效益比为150万美元（敏感性分析范围为每获得一个QALY 100 - 210万美元）。
添加NAT筛查的成本效益超出了大多数医疗保健干预措施的典型范围，但对于既定的血液安全措施而言并非如此。
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