Grégoire Yves, Delage Gilles, Custer Brian, Rochette Samuel, Renaud Christian, Lewin Antoine, Germain Marc
Medical Affairs and Innovation, Héma-Québec, Québec city, Canada.
Héma-Québec, Quebec City, Canada.
Transfusion. 2022 Jun;62(6):1208-1217. doi: 10.1111/trf.16926. Epub 2022 May 13.
The last economic evaluation of pathogen reduction technology (PRT) in Canada was conducted in 2007. We reassessed the cost-effectiveness of PRT in the province of Québec (which has its own blood supplier) and included an evaluation of the potential impact of emerging pathogens on cost-effectiveness.
Decision analytic Markov models were developed to simulate the costs and quality-adjusted life-years (QALY) associated with PRT as an addition to existing safety measures for plasma and platelet products (except for bacterial culture). Models accounted for several infectious and noninfectious transfusion reactions, recipients' productivity losses ensuing from these reactions, and the impact of PRT on platelet function. Scenario analyses were conducted to evaluate the impact of a new highly contagious human immunodeficiency virus (HIV)-like or West Nile virus (WNV)-like pathogen, assuming various epidemiological scenarios.
In the base case, the incremental cost-effectiveness ratio (ICER) of PRT was estimated at $8,088,974/QALY gained. Assuming the presence of an HIV-like pathogen, the ICER was $265,209/QALY gained in the "average transmission" scenario, $1,274,445/QALY gained in the "rapid testing scenario," and $123,063/QALY gained in the "highly contagious" scenario. Assuming the presence of a WNV-like pathogen, the ICER was $7,469,167/QALY gained in the "average transmission" scenario and $6,652,769/QALY gained in the "highly contagious" scenario.
The cost-effectiveness of PRT may substantially improve in the event of a new, blood-borne pathogen. Given their significant impact on cost-effectiveness, the emergence of new pathogens should be considered when deciding whether to adopt PRT.
加拿大上次对病原体灭活技术（PRT）进行的经济评估是在2007年。我们重新评估了PRT在魁北克省（该省有自己的血液供应商）的成本效益，并评估了新出现的病原体对成本效益的潜在影响。
开发了决策分析马尔可夫模型，以模拟将PRT作为血浆和血小板产品（细菌培养除外）现有安全措施的补充所产生的成本和质量调整生命年（QALY）。模型考虑了几种感染性和非感染性输血反应、这些反应导致的受血者生产力损失以及PRT对血小板功能的影响。进行了情景分析，以评估一种新的高传染性人类免疫缺陷病毒（HIV）样或西尼罗河病毒（WNV）样病原体在各种流行病学情景下的影响。
在基础案例中，PRT的增量成本效益比（ICER）估计为每获得一个QALY需8,088,974美元。假设有一种HIV样病原体，在“平均传播”情景下，ICER为每获得一个QALY需265,209美元，在“快速检测情景”下为每获得一个QALY需1,274,445美元，在“高传染性”情景下为每获得一个QALY需123,063美元。假设有一种WNV样病原体，在“平均传播”情景下，ICER为每获得一个QALY需7,469,167美元，在“高传染性”情景下为每获得一个QALY需6,652,769美元。
如果出现一种新的血源性病原体，PRT的成本效益可能会大幅提高。鉴于新病原体对成本效益有重大影响，在决定是否采用PRT时应考虑新病原体的出现。
