AuBuchon J P, Birkmeyer J D, Busch M P
Department of Pathology, Dartmouth-Ilitchcock Medical Center, Lebanon, New Hampshire, USA.
Transfusion. 1997 Jan;37(1):45-51. doi: 10.1046/j.1537-2995.1997.37197176950.x.
This study was designed to estimate the cost-effectiveness of expanding the human immunodeficiency virus (HIV)-testing protocol for donated blood beyond screening for HIV antibodies to further reduce the risk of HIV transmission through transfusion.
A Markov decision analysis model was developed to estimate the cost-effectiveness of HIV antibody testing (at a cost of $5/unit) and of adding to that protocol a second HIV test, either plasma p24 antigen detection or RNA polymerase chain reaction (PCR) (at costs of $5/unit and $8/unit, respectively). Test efficacy was projected from anticipated window-period reductions (6 days for p24 antigen, 11 days for RNA PCR), and donor seroconversion rates were derived from the Retrovirus Epidemiology Donor Study.
On the basis of current estimates of HIV prevalence rates in blood donors (1/10,000) and 16 million annual transfusions in the United States HIV antibody testing prevents 1568 cases of transfusion-acquired HIV infection each year at a cost of $3600 per quality-adjusted year of life saved. The addition of p24 antigen testing would prevent 8 more cases at a net additional cost of $60 million annually ($2.3 million/quality-adjusted life year); RNA PCR testing would prevent 16 more cases at a net additional cost of $96 million annually ($2.0 million/ quality-adjusted life year).
Although expanding the donor HIV screening protocol with p24 antigen or RNA PCR testing will prevent rare cases of transfusion-associated HIV, the cost-effectiveness of such an addition is predicted to be far below that of most medical interventions. Thus, HIV test protocol additions are unlikely to provide cost-effective improvements to blood safety in the United States.
本研究旨在评估将人类免疫缺陷病毒（HIV）献血检测方案从仅筛查HIV抗体扩展至进一步降低输血传播HIV风险的成本效益。
开发了一个马尔可夫决策分析模型，以评估HIV抗体检测（每单位成本5美元）以及在该方案中增加第二项HIV检测（血浆p24抗原检测或RNA聚合酶链反应（PCR），成本分别为每单位5美元和8美元）的成本效益。根据预期的窗口期缩短情况（p24抗原检测为6天，RNA PCR检测为11天）预测检测效果，并从逆转录病毒流行病学献血者研究中得出献血者血清转化率。
根据目前对献血者中HIV流行率的估计（1/10,000）以及美国每年1600万次输血情况，HIV抗体检测每年可预防1568例输血获得性HIV感染，每挽救一个质量调整生命年的成本为3600美元。增加p24抗原检测每年可多预防8例，每年净增成本6000万美元（每质量调整生命年230万美元）；RNA PCR检测每年可多预防16例，每年净增成本9600万美元（每质量调整生命年200万美元）。
尽管采用p24抗原或RNA PCR检测扩展献血者HIV筛查方案将预防罕见的输血相关HIV病例，但预计这种增加的成本效益远低于大多数医疗干预措施。因此，增加HIV检测方案不太可能在美国为血液安全提供具有成本效益的改善。
