Anne Puneeth Babu, Gupta Anubhav, Misra Sanjeev, Sharma Suresh Kumar, Garg Mahendra Kumar, Bajpayee Archana, Bundas Sunita, Bohra Manju, Asirvatham Vasanth
Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences, 342005 Jodhpur, India.
All India Institute of Medical Sciences, 342005 Jodhpur, India.
Indian J Hematol Blood Transfus. 2023 Apr;39(2):317-324. doi: 10.1007/s12288-022-01564-8. Epub 2022 Sep 5.
Transfusion Transmitted infections(TTI) are of significant concern for blood safety. The thalassemia patients who receive multiple transfusions are at an increased risk of TTIs and the Nucleic Acid Test (NAT ) has been advocated for safe blood. Though NAT can reduce the window period compared to serology, cost is a constraint.
The thalassemia patient and NAT yield data from the centralized NAT lab in AIIMS Jodhpur was evaluated for cost-effectiveness using the Markov model. The incremental cost-effectiveness ratio (ICER) was calculated by dividing the difference between the cost for NAT and the cost of medical management of TTI-related complications by the product of the difference in utility value of a TTI health state with time and Gross National Income(GNI) per capita.
Out of the 48,762 samples tested by NAT, 43 samples were discriminated NAT yield all of which were reactive for Hepatitis B (NAT yield of 1:1134). There was no HCV and HIV NAT yield despite HCV being the most prevalent TTI in this population. The cost of this intervention was INR 5,85,14,400. The number of lifetime QALY saved was 1.38 years. The cost of medical management is INR 82,19,114. Therefore the ICER for intervention is INR 3,64,45,860 per QALY saved which is 274 times the GNI per capita of India.
The provision of IDNAT-tested blood for thalassemia patients in Rajasthan state was not found to be cost-effective. Measures to bring down the cost or alternative options to increase blood safety should be explored.
输血传播感染（TTI）是血液安全的重大关注点。接受多次输血的地中海贫血患者感染TTI的风险增加，核酸检测（NAT）已被提倡用于安全输血。尽管与血清学相比，NAT可以缩短窗口期，但成本是一个限制因素。
使用马尔可夫模型评估了焦特布尔全印医学科学研究所集中式NAT实验室的地中海贫血患者和NAT产出数据的成本效益。通过将NAT成本与TTI相关并发症医疗管理成本之间的差异除以TTI健康状态效用值随时间的差异与人均国民总收入（GNI）的乘积，计算增量成本效益比（ICER）。
在通过NAT检测的48762个样本中，有43个样本被鉴别为NAT产出，所有样本均对乙型肝炎呈反应性（NAT产出为1:1134）。尽管丙型肝炎是该人群中最常见的TTI，但没有丙型肝炎和艾滋病毒的NAT产出。该干预措施的成本为58514400印度卢比。挽救的终身质量调整生命年（QALY）数量为1.38年。医疗管理成本为8219114印度卢比。因此，干预的ICER为每挽救一个QALY 36445860印度卢比，是印度人均GNI的274倍。
在拉贾斯坦邦为地中海贫血患者提供经IDNAT检测的血液不具有成本效益。应探索降低成本的措施或提高血液安全性的替代方案。
