Postma M J, van Hulst M, De Wolf J T M, Botteman M, Staginnus U
Groningen University Institute for Drug Exploration/University of Groningen Research Institute of Pharmacy (GUIDE/GRIP), Groningen, the Netherlands.
Transfus Med. 2005 Oct;15(5):379-87. doi: 10.1111/j.1365-3148.2005.00609.x.
The objective of this study is to estimate cost-effectiveness of pathogen inactivation for platelet transfusions in the Netherlands. We used decision tree analysis to evaluate the cost-effectiveness of the addition of pathogen inactivation of pooled platelets to standard procedures for platelet transfusion safety (such as, donor recruitment and screening). Data on transfusions were derived from the University Medical Centre Groningen (the Netherlands) for 1997. Characteristics of platelet recipients (patient group, age, gender and survival) and data/assumptions on viral and bacterial risks were linked to direct and indirect costs/benefits of pathogen inactivation. Post-transfusion survival was simulated with a Markov model. Standard methods for cost-effectiveness were used. Cost-effectiveness was expressed in net costs per life-year gained (LYG) and estimated in baseline- and sensitivity analysis. Sensitivity was analysed with respect to various assumptions including sepsis risk, reduction of the discard rate and discounting. Stochastic analysis to derive 90% simulation intervals (SIs) was performed on sepsis risk. Net costs per LYG for pathogen inactivation were estimated 554,000 euro in the baseline-weighted average over the three patient groups (90% SI: 354,000-1092,500 euro). Sensitivity analysis revealed that cost-effectiveness was insensitive to viral risks and indirect costing, but highly sensitive to the assumed excess transfusions required and discounting of LYG. Given relatively high net costs per LYG that are internationally accepted for blood transfusion safety interventions, our estimated cost-effectiveness figures for pathogen inactivation may reflect acceptable cost-effectiveness in this specific area. Two main assumptions of our model were that the pathogen inactivation was 100% effective in preventing transmission of the pathogens considered and was not associated with major and/or costly adverse reactions. Validation of several crucial parameters is required, in particular the Dutch risk for acquiring and dying of transfusion-related sepsis.
本研究的目的是评估荷兰血小板输注中病原体灭活的成本效益。我们使用决策树分析来评估在血小板输注安全的标准程序（如献血者招募和筛查）中添加混合血小板病原体灭活的成本效益。输血数据来自格罗宁根大学医学中心（荷兰）1997年的数据。血小板接受者的特征（患者组、年龄、性别和生存率）以及病毒和细菌风险的数据/假设与病原体灭活的直接和间接成本/效益相关联。采用马尔可夫模型模拟输血后生存率。使用成本效益的标准方法。成本效益以每获得一个生命年（LYG）的净成本表示，并在基线分析和敏感性分析中进行估计。针对包括败血症风险、废弃率降低和贴现等各种假设进行敏感性分析。对败血症风险进行了随机分析以得出90%的模拟区间（SIs）。在三个患者组的基线加权平均值中，病原体灭活每LYG的净成本估计为554,000欧元（90% SI：354,000 - 1,092,500欧元）。敏感性分析表明，成本效益对病毒风险和间接成本核算不敏感，但对假设所需的额外输血和LYG的贴现高度敏感。鉴于国际上接受的输血安全干预每LYG的净成本相对较高，我们估计的病原体灭活成本效益数字可能反映了该特定领域可接受的成本效益。我们模型的两个主要假设是病原体灭活在预防所考虑的病原体传播方面100%有效，并且与重大和/或昂贵的不良反应无关。需要对几个关键参数进行验证，特别是荷兰获得输血相关败血症和死于输血相关败血症的风险。
