Hornbrook M C, Dodd R Y, Jacobs P, Friedman L I, Sherman K E
N Engl J Med. 1982 Nov 18;307(21):1315-21. doi: 10.1056/NEJM198211183072105.
Recent studies have established a relation between elevated alanine aminotransferase levels in donor blood and the incidence of non-A, non-B hepatitis in recipients of such blood. Routine testing of donor blood for alanine aminotransferase activity in order to reduce hepatitis is not currently supported, largely because the results of such testing are unknown. We assessed the potential economic benefits of screening donor blood for alanine aminotransferase as a means to reduce post-transfusion hepatitis. Benefits, defined as the expected costs of hepatitis potentially avoided, ranged from $898 to $31,629 per 1000 blood units collected. This wide range reflected lack of information about the natural history of non-A, non-B hepatitis. Costs were defined as the direct costs of testing and the indirect costs associated with loss of blood product, additional donor recruitment, and informing donors of their abnormal aminotransferase levels; costs ranged from $3,151 to $4,003 per 1000 units. Our results suggest that if prospective studies demonstrate that exclusion of blood with elevated aminotransferase levels decreases non-A, non-B hepatitis in recipients, the net economic impact may be positive. However, because of major uncertainties about the medical consequences of non-A, non-B hepatitis, the benefit estimates are so broad that they preclude a definitive policy decision.
近期研究已证实，供血者血液中丙氨酸转氨酶水平升高与接受此类血液者的非甲非乙型肝炎发病率之间存在关联。目前不支持为降低肝炎发病率而对供血者血液进行丙氨酸转氨酶活性的常规检测，主要原因是此类检测结果尚不清楚。我们评估了对供血者血液进行丙氨酸转氨酶筛查作为降低输血后肝炎的一种手段的潜在经济效益。效益定义为可能避免的肝炎预期成本，每采集1000单位血液，效益范围从898美元到31629美元不等。如此大的范围反映了对非甲非乙型肝炎自然史缺乏了解。成本定义为检测的直接成本以及与血液制品损失、额外招募供血者以及告知供血者其丙氨酸转氨酶水平异常相关的间接成本；每1000单位成本范围从3151美元到4003美元不等。我们的结果表明，如果前瞻性研究表明排除丙氨酸转氨酶水平升高的血液可降低接受者的非甲非乙型肝炎发病率，那么净经济影响可能是积极的。然而，由于非甲非乙型肝炎的医学后果存在重大不确定性，效益估计范围如此之广，以至于无法做出明确的政策决策。
