The cost-effectiveness of NAT for HIV, HCV, and HBV in whole-blood donations.

BACKGROUND The risk of viral infection associated with blood transfusion is lower than ever before because of aggressive screening and testing practices. NAT technology has lowered that risk even further but at an additional cost to the health-care system. STUDY DESIGN AND METHODS Marginal cost-effectiveness of NAT for HIV, HCV, and HBV in whole-blood donations was calculated with a previously published Markov decision model. This model was updated with disease incidence data from all 2001 American Red Cross whole-blood donations as well as window-period data from the Retrovirus Epidemiology Donor Study (REDS). RESULTS Whole-blood donation NAT for HIV and HCV is expected to cost between 155 US dollars million (minipool NAT) and 428 million US dollars(single-donation NAT) per year in the US and avert 4 to 7 HIV infections and 56 to 59 HCV infections. Adding HBV NAT would be expected to avert 9 to 37 HBV infections at an additional cost of between 39 million US dollars and 130 million US dollars per year. Overall, NAT would cost between 4.7 million US dollars and 11.2 million US dollars per quality-adjusted life-year saved. Discontinuing HIV p24 antigen and HBc testing would offset this somewhat. CONCLUSIONS The cost-effectiveness of whole-blood NAT is poor. The testing cost would need to decrease significantly to bring the cost-effectiveness in line with most other accepted medical practices.