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. 2023 Jun;118(6):471-479.
doi: 10.1111/vox.13429. Epub 2023 May 14.

Removing hepatitis C antibody testing for Australian blood donations: A cost-effectiveness analysis

Qinglu Cheng  1 , Veronica C Hoad  2 , Avijoy Roy Choudhury  3 , Clive R Seed  2 , Peter Bentley  2   3 , Sophy T F Shih  1 , Jisoo A Kwon  1 , Richard T Gray  1 , Virginia Wiseman  1   4
Affiliations

Removing hepatitis C antibody testing for Australian blood donations: A cost-effectiveness analysis

Qinglu Cheng et al. Vox Sang. 2023 Jun.

Abstract

Background and objectives: The risk of transfusion-transmitted hepatitis C virus (HCV) infections is extremely low in Australia. This study aims to conduct a cost-effectiveness analysis of different testing strategies for HCV infection in blood donations.

Materials and methods: The four testing strategies evaluated in this study were universal testing with both HCV antibody (anti-HCV) and nucleic acid testing (NAT); anti-HCV and NAT for first-time donations and NAT only for repeat donations; anti-HCV and NAT for transfusible component donations and NAT only for plasma for further manufacture; and universal testing with NAT only. A decision-analytical model was developed to assess the cost-effectiveness of alternative HCV testing strategies. Sensitivity analysis and threshold analysis were conducted to account for data uncertainty.

Results: The number of potential transfusion-transmitted cases of acute hepatitis C and chronic hepatitis C was approximately zero in all four strategies. Universal testing with NAT only was the most cost-effective strategy due to the lowest testing cost. The threshold analysis showed that for the current practice to be cost-effective, the residual risks of other testing strategies would have to be at least 1 HCV infection in 2424 donations, which is over 60,000 times the baseline residual risk (1 in 151 million donations).

Conclusion: The screening strategy for HCV in blood donations currently implemented in Australia is not cost-effective compared with targeted testing or universal testing with NAT only. Partial or total removal of anti-HCV testing would bring significant cost savings without compromising blood recipient safety.

Keywords: blood donation testing; blood safety; cost effectiveness; hepatitis C.

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Conflict of interest statement

All authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Decision tree model structure for hepatitis C virus (HCV) testing in blood donations. Anti‐HCV, hepatitis C virus antibody; NAT, nucleic acid testing.
FIGURE 2
FIGURE 2
Markov model structure for chronic hepatitis C disease progression. SVR, sustained virological response.
See this image and copyright information in PMC

References

    1. Kirby Institute UNSW Sydney and Australian Red Cross Lifeblood . Transfusion‐transmissible infections in Australia: 2022 surveillance report. Available from: https://kirby.unsw.edu.au/report/transfusion-transmissible-infections-au...
    1. Kirby Institute UNSW Sydney, the Australian Red Cross Blood Service . Transfusion‐transmissible infections in Australia: 2020 surveillance report. Available from: https://kirby.unsw.edu.au/report/transfusion-transmissible-infections-au...
    1. Bruhn R, Lelie N, Busch M, Kleinman S. Relative efficacy of nucleic acid amplification testing and serologic screening in preventing hepatitis C virus transmission risk in seven international regions. Transfusion. 2015;55:1195–205. - PubMed
    1. Centers for Disease Control and Prevention . Blood safety basics. Available from: https://www.cdc.gov/bloodsafety/basics.html
    1. Joint United Kingdome Blood Transfusion and Tissue Transplantation Services. Guidelines for the blood transfusion services in the United Kingdom. 8th ed. London: Stationery Office; 2013.

Supplementary concepts