Screening the Blood Supply for Zika Virus in the 50 U.S. States and Puerto Rico: A Cost-Effectiveness Analysis

Abstract

Background: In 2016, universal individual donation nucleic acid testing (ID-NAT) of donated blood for Zika virus began in U.S. states and territories.

Objective: To assess the cost-effectiveness of universal ID-NAT in the first year of screening compared with alternatives for the 50 states and separately for Puerto Rico.

Design: Microsimulation that captured Zika-related harms to transfusion recipients, sexual partners, and their infants.

Data sources: National testing results compiled by AABB and costs, utilities, and outcome probabilities estimated from the literature.

Target population: Transfusion recipients.

Time horizon: Lifetime.

Perspective: Societal.

Intervention: Universal ID-NAT, universal mini-pool NAT (MP-NAT), and ID-NAT exclusively for components transfused to women of childbearing age. Seasonally targeted strategies in Puerto Rico and geographically targeted strategies in the 50 states were also considered.

Outcome measures: Costs, quality-adjusted life-years (QALYs), and outcomes.

Results of base-case analysis: In Puerto Rico, MP-NAT exclusively during high mosquito season was cost-effective at $81 123 per QALY (95% CI, -$49 138 to $978 242 per QALY). No screening policy was cost-effective in the 50 states. Universal ID-NAT cost $341 million per QALY (CI, $125 million to $2.90 billion per QALY) compared with no screening in the 50 states.

Results of sensitivity analysis: In Puerto Rico, MP-NAT only during the season of high mosquito activity was most cost-effective in 64% of probabilistic sensitivity analysis iterations. In the 50 states, no intervention was cost-effective in 99.99% of iterations. Cost-effectiveness was highly dependent on the rate of assumed infectious donations.

Limitation: Data were limited on the component-specific transmissibility of Zika and long-term sequelae of infection.

Conclusion: Screening was cost-effective only in the high mosquito season in Puerto Rico, and no evaluated screening policy was cost-effective in the 50 states. During periods with lower rates of Zika-infectious donations, the cost-effectiveness of screening will be even less favorable.

Primary funding source: None.