Janssen M P, van Hulst M, Custer B
Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.
Transfusion Technology Assessment Department, Sanquin Research, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands.
Vox Sang. 2017 Aug;112(6):518-525. doi: 10.1111/vox.12543. Epub 2017 Jun 22.
The cost-utility of safety interventions is becoming increasingly important as a driver of implementation decisions. The aim of this study was to compare the cost-utility of different blood screening strategies in various settings, and to analyse the extent and cause of differences in health economic results.
For eight Western countries (Australia, Canada, Denmark, Finland, France, The Netherlands, UK and the United States of America), data were collected on donor and recipient populations, blood products, screening tests, and on patient treatment practices and costs. An existing ISBT web-tool model was used to assess the cost-utility of various strategies for HIV, HCV and HBV screening.
The cost-utility ratio of serology screening for these eight countries ranges between -11 000 and 92 000 US$ per QALY, and for NAT between -12 000 and 113 000 US$ per QALY when compared to no screening. Combined serology and NAT ranges between 600 and 217 000 US$ per QALY. The incremental cost-utility of NAT after implementation of serology screening ranges from 2 231 000 to 15 778 000 US$ per QALY.
There are substantial differences in costs per QALY between countries for various HIV, HBV and HCV screening strategies. These differences are primarily caused by costs of screening tests and infection rates in the donor population. Within each country, similar cost per QALY results for serology and NAT compared to no screening, coupled with evidence of limited value of serology and NAT together prompts the need for further discussion on the acceptability of parallel testing by serology and NAT.
作为实施决策的驱动因素，安全干预措施的成本效益正变得越来越重要。本研究的目的是比较不同血液筛查策略在不同环境下的成本效益，并分析健康经济结果差异的程度和原因。
收集了八个西方国家（澳大利亚、加拿大、丹麦、芬兰、法国、荷兰、英国和美国）关于献血者和受血者人群、血液制品、筛查试验以及患者治疗实践和成本的数据。使用现有的国际输血协会网络工具模型评估了各种艾滋病毒、丙型肝炎病毒和乙型肝炎病毒筛查策略的成本效益。
与不进行筛查相比，这八个国家血清学筛查的成本效益比为每质量调整生命年-11000至92000美元，核酸检测为每质量调整生命年-12000至113000美元。血清学和核酸检测联合使用时，每质量调整生命年为600至217000美元。在实施血清学筛查后，核酸检测的增量成本效益为每质量调整生命年2231000至15778000美元。
各国在各种艾滋病毒、乙型肝炎病毒和丙型肝炎病毒筛查策略的每质量调整生命年成本方面存在显著差异。这些差异主要是由筛查试验成本和献血人群中的感染率造成的。在每个国家内，与不进行筛查相比，血清学和核酸检测的每质量调整生命年结果相似，再加上血清学和核酸检测价值有限的证据，促使人们需要进一步讨论血清学和核酸检测并行检测的可接受性。
