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Anne PB, Gupta A, Misra S, Sharma SK, Garg MK, Bajpayee A, Bundas S, Bohra M, Asirvatham V. Economic Evaluation of Nucleic Acid Testing for Screening of Blood Donations for Thalassemia Patients (ECONAT) in Western India. Indian J Hematol Blood Transfus 2023; 39:317-324. [PMID: 37006984 PMCID: PMC10064373 DOI: 10.1007/s12288-022-01564-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/13/2022] [Indexed: 11/27/2022] Open
Abstract
Background Transfusion Transmitted infections(TTI) are of significant concern for blood safety. The thalassemia patients who receive multiple transfusions are at an increased risk of TTIs and the Nucleic Acid Test (NAT ) has been advocated for safe blood. Though NAT can reduce the window period compared to serology, cost is a constraint. Methods The thalassemia patient and NAT yield data from the centralized NAT lab in AIIMS Jodhpur was evaluated for cost-effectiveness using the Markov model. The incremental cost-effectiveness ratio (ICER) was calculated by dividing the difference between the cost for NAT and the cost of medical management of TTI-related complications by the product of the difference in utility value of a TTI health state with time and Gross National Income(GNI) per capita. Results Out of the 48,762 samples tested by NAT, 43 samples were discriminated NAT yield all of which were reactive for Hepatitis B (NAT yield of 1:1134). There was no HCV and HIV NAT yield despite HCV being the most prevalent TTI in this population. The cost of this intervention was INR 5,85,14,400. The number of lifetime QALY saved was 1.38 years. The cost of medical management is INR 82,19,114. Therefore the ICER for intervention is INR 3,64,45,860 per QALY saved which is 274 times the GNI per capita of India. Conclusions The provision of IDNAT-tested blood for thalassemia patients in Rajasthan state was not found to be cost-effective. Measures to bring down the cost or alternative options to increase blood safety should be explored.
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Affiliation(s)
- Puneeth Babu Anne
- Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences, 342005 Jodhpur, India
| | - Anubhav Gupta
- Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences, 342005 Jodhpur, India
| | - Sanjeev Misra
- All India Institute of Medical Sciences, 342005 Jodhpur, India
| | | | - Mahendra Kumar Garg
- Department of General Medicine, All India Institute of Medical Sciences, 342005 Jodhpur, India
| | - Archana Bajpayee
- Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences, 342005 Jodhpur, India
| | - Sunita Bundas
- Department of Immunohematology and Transfusion Medicine, S.M.S. Medical college, 302004 Jaipur, India
| | - Manju Bohra
- Department of Immunohematology and Transfusion Medicine, Dr. S. N. Medical College, 342003 Jodhpur, India
| | - Vasanth Asirvatham
- Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences, 342005 Jodhpur, India
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Assessing the capacity of Ghana to introduce health technology assessment: a systematic review of economic evaluations conducted in Ghana. Int J Technol Assess Health Care 2020; 36:500-507. [PMID: 32981532 DOI: 10.1017/s0266462320000689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Ghana is in the process of formally introducing health technology assessment (HTA) for health decision making. Similar to other low- and middle-income countries, evidence suggests that the lack of data and human capacity is a major barrier to the conduct and use of HTA. This study assessed the current human and data capacity available in Ghana to undertake HTA. METHODS As economic evaluation (EE) forms an integral part of HTA, a systematic review of EE studies undertaken in Ghana was conducted to identify the quality and number of studies available, methods and source of data used, and local persons involved. The literature search was undertaken in EMBASE (including MEDLINE), PUBMED, and Google Scholar. The quality of studies was evaluated using the Consolidated Health Economics Evaluation Reporting Standards. The number of local Ghanaians who contributed to authorship were used as a proxy for assessing human capacity for HTA. RESULTS Thirty-one studies were included in the final review. Overall, studies were of good quality. Studies derived their effectiveness, resource utilization and cost data mainly from Ghana. The most common source of cost data was from the National Health Insurance Scheme pricing list for medicines and tariffs. Effectiveness data were mostly derived from either single study or intervention programs. Sixty out of 199 authors were Ghanaians (30 percent); these authors were mostly involved in data collection and study conceptualization. CONCLUSIONS Human capacity for HTA in Ghana is limited. To introduce HTA successfully in Ghana, policy makers would need to develop more local capacity to undertake Ghanaian-specific HTA.
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3
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Vermeulen M, Chowdhury D, Swanevelder R, Grebe E, Brambilla D, Jentsch U, Busch M, Van Zyl G, Murphy EL. HIV incidence in South African blood donors from 2012 to 2016: a comparison of estimation methods. Vox Sang 2020; 116:71-80. [PMID: 32762088 DOI: 10.1111/vox.12987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Measuring incidence is important for monitoring and maintaining the safety of the blood supply. Blood collected from repeat-donors has provided the opportunity to follow blood donors over time and has been used to estimate the incidence of viral infections. These incidence estimates have been extrapolated to first-time donors using the ratio of NAT yield cases in first-time versus repeat-donors. We describe a model to estimate incidence in first-time donors using the limiting antigen (LAg) avidity assay and compare its results with those from established models. METHODS HIV-positive first-time donations were tested for recency using the LAg assay. Three models were compared; incidence estimated for (1) first-time donors using LAg avidity, (2) first-time and repeat-donors separately using the NAT yield window period (WP) model and (3) repeat-donors using the incidence/WP model. RESULTS HIV incidence in first-time donors was estimated at 3·32 (CI 3·11, 3·55) and 3·81 (CI 3·07, 4·73) per 1000 PY using the LAg assay and NAT yield WP models, respectively. Incidence in repeat-donors was between 2·0- and 2·5-fold lower than in first-time donors estimated at 1·56 (CI 1·37, 1·77) and 1·94 (CI 1·86-2·01) per 1000 PY using the NAT yield/WP and incidence/WP models, respectively. CONCLUSION Testing HIV-positive donations using the LAg assay provides a reliable method to estimate incidence in first-time donors for countries that collect the majority of blood from first-time donors and do not screen with NAT.
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Affiliation(s)
- Marion Vermeulen
- The South African National Blood Service, Roodepoort, South Africa
| | | | | | - Eduard Grebe
- Vitalant Research Institute, San Francisco, CA, USA
| | | | - Ute Jentsch
- The South African National Blood Service, Roodepoort, South Africa
| | | | - Gert Van Zyl
- Stellenbosch University, Cape Town, South Africa
| | - Edward L Murphy
- Vitalant Research Institute, San Francisco, CA, USA.,University of California San Francisco, San Francisco, CA, USA
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4
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Heffernan A, Barber E, Cook NA, Gomaa AI, Harley YX, Jones CR, Lim AG, Mohamed Z, Nayagam S, Ndow G, Shah R, Sonderup MW, Spearman CW, Waked I, Wilkinson RJ, Taylor-Robinson SD. Aiming at the Global Elimination of Viral Hepatitis: Challenges Along the Care Continuum. Open Forum Infect Dis 2017; 5:ofx252. [PMID: 29354656 PMCID: PMC5767952 DOI: 10.1093/ofid/ofx252] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A recent international workshop, organized by the authors, analyzed the obstacles facing the ambitious goal of eliminating viral hepatitis globally. We identified several policy areas critical to reaching elimination targets. These include providing hepatitis B birth-dose vaccination to all infants within 24 hours of birth, preventing the transmission of blood-borne viruses through the expansion of national hemovigilance schemes, implementing the lessons learned from the HIV epidemic regarding safe medical practices to eliminate iatrogenic infection, adopting point-of-care testing to improve coverage of diagnosis, and providing free or affordable hepatitis C treatment to all. We introduce Egypt as a case study for rapid testing and treatment scale-up: this country offers valuable insights to policy makers internationally, not only regarding how hepatitis C interventions can be expeditiously scaled-up, but also as a guide for how to tackle the problems encountered with such ambitious testing and treatment programs.
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Affiliation(s)
- Alastair Heffernan
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
| | - Ella Barber
- Division of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK.,Médecins Sans Frontières, London, UK
| | - Nicola A Cook
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Asmaa I Gomaa
- Hepatology Department, National Liver Institute, Menoufiya University, Shebeen El-Kom, Egypt
| | - Yolande X Harley
- Research Office, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Christopher R Jones
- Division of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Zameer Mohamed
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Liver and Antiviral Unit, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
| | - Shevanthi Nayagam
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK.,Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Gibril Ndow
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Hepatitis Unit, Disease Control and Elimination, MRC Unit, Banjul, The Gambia
| | - Rajiv Shah
- Infectious Diseases Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Mark W Sonderup
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Imam Waked
- Hepatology Department, National Liver Institute, Menoufiya University, Shebeen El-Kom, Egypt
| | - Robert J Wilkinson
- Division of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK.,Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Tuberculosis Laboratory, The Francis Crick Institute, London, UK
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5
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Janssen MP, van Hulst M, Custer B. An assessment of differences in costs and health benefits of serology and NAT screening of donations for blood transfusion in different Western countries. Vox Sang 2017. [DOI: 10.1111/vox.12543] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M. P. Janssen
- Julius Center for Health Sciences and Primary Care; UMC Utrecht; Utrecht The Netherlands
- Transfusion Technology Assessment Department; Sanquin Research; Sanquin Blood Supply Foundation; Amsterdam The Netherlands
| | - M. van Hulst
- Department of Clinical Pharmacy and Toxicology; Martini Hospital; Groningen The Netherlands
- Department of PharmacoTherapy, -Epidemiology & -Economics; Department of Pharmacy; University of Groningen; Groningen The Netherlands
| | - B. Custer
- Blood Systems Research Institute; San Francisco CA USA
- Department of Laboratory Medicine; UCSF; San Francisco CA USA
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6
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Custer B, Janssen MP, Hubben G, Vermeulen M, van Hulst M. Development of a web-based application and multicountry analysis framework for assessing interdicted infections and cost-utility of screening donated blood for HIV, HCV and HBV. Vox Sang 2017; 112:526-534. [PMID: 28597489 DOI: 10.1111/vox.12538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 03/06/2017] [Accepted: 04/25/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Most countries test donations for HIV, HCV and HBV using serology with or without nucleic acid testing (NAT). Cost-utility analyses provide information on the relative value of different screening options. The aim of this project was to develop an open access risk assessment and cost-utility analysis web-tool for assessing HIV, HCV and HBV screening options (http://www.isbtweb.org/working-parties/transfusion-transmitted-infectious-diseases/). An analysis for six countries (Brazil, Ghana, the Netherlands, South Africa, Thailand and USA) was conducted. MATERIALS AND METHODS Four strategies; (1) antibody assays (Abs) for HIV and HCV + HBsAg, (2) antibody assays that include antigens for HIV and HCV (Combo) + HBsAg, (3) NAT in minipools of variable size (MP NAT) and (4) individual donation (ID) NAT can be evaluated using the tool. Country-specific data on donors, donation testing results, recipient outcomes and costs are entered using the online interface. Results obtained include the number infections interdicted using each screening options, and the (incremental and average) cost-utility of the options. RESULTS In each of the six countries evaluated, the use of antibody assays is cost effective or even cost saving. NAT has varying cost-utility depending on the setting, and where adopted, the incremental cost-utility exceeds any previously defined or proposed threshold in each country. CONCLUSION The web-tool allows an assessment of infectious units interdicted and value for money of different testing strategies. Regardless of gross national income (GNI) per capita, countries appear willing to dedicate healthcare resources to blood supply safety in excess of that for other sectors of health care.
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Affiliation(s)
- B Custer
- Blood Systems Research Institute, San Francisco, CA, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - M P Janssen
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.,Transfusion Technology Assessment Department, Sanquin Research, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | | | - M Vermeulen
- South African National Blood Service, Johannesburg, South Africa
| | - M van Hulst
- Department of PharmacoTherapy, Epidemiology & Economics, University of Groningen, Groningen, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Martini Hospital, Groningen, The Netherlands
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7
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Mafirakureva N, Mapako T, Khoza S, Emmanuel JC, Marowa L, Mvere D, Postma MJ, van Hulst M. Cost effectiveness of adding nucleic acid testing to hepatitis B, hepatitis C, and human immunodeficiency virus screening of blood donations in Zimbabwe. Transfusion 2016; 56:3101-3111. [PMID: 27696441 DOI: 10.1111/trf.13858] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/03/2016] [Accepted: 08/11/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim of this study was to assess the cost effectiveness of introducing individual-donation nucleic acid testing (ID-NAT), in addition to serologic tests, compared with the exclusive use of serologic tests for the identification of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) I and II among blood donors in Zimbabwe. STUDY DESIGN AND METHODS The costs, health consequences, and cost effectiveness of adding ID-NAT to serologic tests, compared with serologic testing alone, were estimated from a health care perspective using a decision-analytic model. RESULTS The introduction of ID-NAT in addition to serologic tests would lower the risk of HBV, HCV, and HIV transmission to 46.9, 0.3, and 2.7 per 100,000 donations, respectively. ID-NAT would prevent an estimated 25, 6, and 9 HBV, HCV, and HIV transfusion-transmitted infections per 100,000 donations, respectively. The introduction of this intervention would result in an estimated 212 quality-adjusted life-years (QALYs) gained. The incremental cost-effectiveness ratio is estimated at US$17,774/QALY, a value far more than three times the gross national income per capita for Zimbabwe. CONCLUSION Although the introduction of NAT could further improve the safety of the blood supply, current evidence suggests that it cannot be considered cost effective. Reducing the test costs for NAT through efficient donor recruitment, negotiating the price of reagents, and the efficient use of technology will improve cost effectiveness.
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Affiliation(s)
- Nyashadzaishe Mafirakureva
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,National Blood Service Zimbabwe, University of Zimbabwe, Harare, Zimbabwe
| | - Tonderai Mapako
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,National Blood Service Zimbabwe, University of Zimbabwe, Harare, Zimbabwe
| | - Star Khoza
- Department of Clinical Pharmacology, University of Zimbabwe, Harare, Zimbabwe
| | - Jean C Emmanuel
- National Blood Service Zimbabwe, University of Zimbabwe, Harare, Zimbabwe
| | - Lucy Marowa
- National Blood Service Zimbabwe, University of Zimbabwe, Harare, Zimbabwe
| | - David Mvere
- National Blood Service Zimbabwe, University of Zimbabwe, Harare, Zimbabwe
| | - Maarten J Postma
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Institute of Science in Healthy Aging & Healthcare (SHARE), University Medical Center Groningen
| | - Marinus van Hulst
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Martini Hospital, Groningen, The Netherlands
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8
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Aprahamian H, Bish DR, Bish EK. Residual risk and waste in donated blood with pooled nucleic acid testing. Stat Med 2016; 35:5283-5301. [PMID: 27488928 DOI: 10.1002/sim.7066] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 11/09/2022]
Abstract
An accurate estimation of the residual risk of transfusion-transmittable infections (TTIs), which includes the human immunodeficiency virus (HIV), hepatitis B and C viruses (HBV, HCV), among others, is essential, as it provides the basis for blood screening assay selection. While the highly sensitive nucleic acid testing (NAT) technology has recently become available, it is highly costly. As a result, in most countries, including the United States, the current practice for human immunodeficiency virus, hepatitis B virus, hepatitis C virus screening in donated blood is to use pooled NAT. Pooling substantially reduces the number of tests required, especially for TTIs with low prevalence rates. However, pooling also reduces the test's sensitivity, because the viral load of an infected sample might be diluted by the other samples in the pool to the point that it is not detectable by NAT, leading to potential TTIs. Infection-free blood may also be falsely discarded, resulting in wasted blood. We derive expressions for the residual risk, expected number of tests, and expected amount of blood wasted for various two-stage pooled testing schemes, including Dorfman-type and array-based testing, considering infection progression, infectivity of the blood unit, and imperfect tests under the dilution effect and measurement errors. We then calibrate our model using published data and perform a case study. Our study offers key insights on how pooled NAT, used within different testing schemes, contributes to the safety and cost of blood. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Hrayer Aprahamian
- Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, U.S.A..
| | - Douglas R Bish
- Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, U.S.A
| | - Ebru K Bish
- Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, U.S.A
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9
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Mapako T, Janssen MP, Mvere DA, Emmanuel JC, Rusakaniko S, Postma MJ, van Hulst M. Impact of using different blood donor subpopulations and models on the estimation of transfusion transmission residual risk of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus in Zimbabwe. Transfusion 2016; 56:1520-8. [PMID: 26801952 DOI: 10.1111/trf.13472] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 11/26/2015] [Accepted: 12/05/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Various models for estimating the residual risk (RR) of transmission of infections by blood transfusion have been published mainly based on data from high-income countries. However, to obtain the data required for such an assessment remains challenging for most developing settings. The National Blood Service Zimbabwe (NBSZ) adapted a published incidence-window period (IWP) model, which has less demanding data requirements. In this study we assess the impact of various definitions of blood donor subpopulations and models on RR estimates. We compared the outcomes of two published models and an adapted NBSZ model. STUDY DESIGN AND METHODS The Schreiber IWP model (Model 1), an amended version (Model 2), and an adapted NBSZ model (Model 3) were applied. Variably the three models include prevalence, incidence, preseroconversion intervals, mean lifetime risk, and person-years at risk. Annual mean RR estimates and 95% confidence intervals for each of the three models for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) were determined using NBSZ blood donor data from 2002 through 2011. RESULTS The annual mean RR estimates for Models 1 through 3 were 1 in 6542, 5805, and 6418, respectively for HIV; 1 in 1978, 2027, and 1628 for HBV; and 1 in 9588, 15,126, and 7750, for HCV. CONCLUSIONS The adapted NBSZ model provided comparable results to the published methods and these highlight the high occurrence of HBV in Zimbabwe. The adapted NBSZ model could be used as an alternative to estimate RRs when in settings where two repeat donations are not available.
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Affiliation(s)
- Tonderai Mapako
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, the Netherlands.,National Blood Service Zimbabwe, Harare, Zimbabwe
| | - Mart P Janssen
- Julius Center for Health Science and Primary Health Care, University Medical Center Utrecht, the Netherlands
| | | | | | - Simbarashe Rusakaniko
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Maarten J Postma
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, the Netherlands.,Institute of Science in Healthy Aging & Health caRE (SHARE), University Medical Center Groningen (UMCG)
| | - Marinus van Hulst
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, the Netherlands.,Department of Clinical Pharmacy and Toxicology, Martini Hospital, Groningen, the Netherlands
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10
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Laperche S, Nübling CM, Stramer SL, Brojer E, Grabarczyk P, Yoshizawa H, Kalibatas V, El Elkyabi M, Moftah F, Girault A, van Drimmelen H, Busch MP, Lelie N. Sensitivity of hepatitis C virus core antigen and antibody combination assays in a global panel of window period samples. Transfusion 2015; 55:2489-98. [PMID: 26013970 DOI: 10.1111/trf.13179] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 04/08/2015] [Accepted: 04/08/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) antigen and antibody combination assays have been launched as a cost-effective alternative to nucleic acid testing (NAT) for reducing the antibody-negative window period (WP). Later, a HCV antigen chemiluminescence immunoassay (CLIA) became available. STUDY DESIGN AND METHODS A panel composed of 337 HCV NAT-yield samples that were characterized for viral load (VL) and genotype was used to compare the sensitivity of two combination enzyme-linked immunosorbent assays (Monolisa, Bio-Rad; and Murex, formerly Abbott) and a HCV antigen CLIA (Abbott). Analytic sensitivity was compared with HCV RNA detection using Ultrio (Grifols) by testing serial dilutions of 10 genotype (gt)1 to gt4 samples. RESULTS HCV antigen CLIA detected 92.4% of samples, whereas Monolisa and Murex detected 38.3 and 47.5%, respectively. In the HCV RNA VL range of 10(5) to 10(7) IU/mL, Monolisa and Murex detected 38% to 56% of gt1, 85% to 78% of gt2, and 21% to 37% of gt3. The overall geometric mean 50% limit of detection (range) of Ultrio on gt1 to gt4 dilution series was 3.5 (1.2-7.7) copies/mL, compared to 3.3 × 10(6) (4.4 × 10(5) -2.7 × 10(7) ), 3.4 × 10(6) (2.2 × 10(5) -4.2 × 10(7) ), and 2728 (415-7243) copies/mL for Monolisa, Murex, and HCV antigen CLIA, respectively. CONCLUSION Analytical sensitivity of NAT was on average 1 million- and 780-fold higher than combination assays and HCV antigen CLIA, respectively. Relative sensitivities of combination assays differed for genotypes with Murex being more sensitive for gt1 and gt3 and Monolisa more sensitive for gt2. Although being less sensitive than NAT, combination assays could be considered in resource-limited settings since they detect 38% to 47% of seronegative WP donations.
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Affiliation(s)
- Syria Laperche
- Institut National de la Transfusion Sanguine (INTS), Département d'Études des Agents Transmissibles par le Sang, Centre National de Reference pour les Hepatites B et C en Transfusion, F-75015 Paris, France
| | - C Micha Nübling
- Section of Molecular Virology, Paul Ehrlich Institute, Langen, Germany
| | - Susan L Stramer
- Scientific Support Office, American Red Cross, Gaithersburg, Maryland
| | - Ewa Brojer
- Institute of Haematology and Transfusion Medicine, Warsaw, Poland
| | - Piotr Grabarczyk
- Institute of Haematology and Transfusion Medicine, Warsaw, Poland
| | - Hiroshi Yoshizawa
- Study Group of NAT Standardization under the Ministry of Health, Labor and Welfare of Japan (2001-2003), Tokyo, Japan
| | | | | | | | - Annie Girault
- Institut National de la Transfusion Sanguine (INTS), Département d'Études des Agents Transmissibles par le Sang, Centre National de Reference pour les Hepatites B et C en Transfusion, F-75015 Paris, France
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11
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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. [DOI: 10.1111/trf.13024] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 12/19/2014] [Accepted: 12/20/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Roberta Bruhn
- Blood Systems Research Institute; San Francisco California
| | | | - Michael Busch
- Blood Systems Research Institute; San Francisco California
| | - Steven Kleinman
- University of British Columbia; Victoria British Columbia Canada
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12
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The impact of external donor support through the U.S. President's Emergency Plan for AIDS Relief on the cost of red cell concentrate in Namibia, 2004-2011. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 13:240-7. [PMID: 25369616 DOI: 10.2450/2014.0122-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 08/21/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND External assistance can rapidly strengthen health programmes in developing countries, but such funding can also create sustainability challenges. From 2004-2011, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) provided more than $ 8 million to the Blood Transfusion Service of Namibia (NAMBTS) for supplies, equipment, and staff salaries. This analysis describes the impact that support had on actual production costs and the unit prices charged for red cell concentrate (RCC) units issued to public sector hospitals. MATERIAL AND METHODS A costing system developed by NAMBTS to set public sector RCC unit prices was used to describe production costs and unit prices during the period of PEPFAR scale-up (2004-2009) and the 2 years in which PEPFAR support began to decline (2010-2011). Hypothetical production costs were estimated to illustrate differences had PEPFAR support not been available. RESULTS Between 2004-2006, NAMBTS sold 22,575 RCC units to public sector facilities. During this time, RCC unit prices exceeded per unit cost-recovery targets by between 40.3% (US$ 16.75 or N$ 109.86) and 168.3% (US$ 48.72 or N$ 333.28) per year. However, revenue surpluses dwindled between 2007 and 2011, the final year of the study period, when NAMBTS sold 20,382 RCC units to public facilities but lost US$23.31 (N$ 170.43) on each unit. DISCUSSION PEPFAR support allowed NAMBTS to leverage domestic cost-recovery revenue to rapidly increase blood collections and the distribution of RCC. However, external support kept production costs lower than they would have been without PEPFAR. If PEPFAR funds had not been available, RCC prices would have needed to increase by 20% per year to have met annual cost-recovery targets and funded the same level of investments as were made with PEPFAR support. Tracking the subsidising influence of external support can help blood services make strategic investments and plan for unit price increases as external funds are withdrawn.
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Bish DR, Bish EK, Xie RS, Stramer SL. Going beyond “same-for-all” testing of infectious agents in donated blood. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/0740817x.2014.882038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bish EK, Ragavan PK, Bish DR, Slonim AD, Stramer SL. A probabilistic method for the estimation of residual risk in donated blood. Biostatistics 2014; 15:620-35. [PMID: 24784858 DOI: 10.1093/biostatistics/kxu017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The residual risk (RR) of transfusion-transmitted infections, including the human immunodeficiency virus and hepatitis B and C viruses, is typically estimated by the incidence[Formula: see text]window period model, which relies on the following restrictive assumptions: Each screening test, with probability 1, (1) detects an infected unit outside of the test's window period; (2) fails to detect an infected unit within the window period; and (3) correctly identifies an infection-free unit. These assumptions need not hold in practice due to random or systemic errors and individual variations in the window period. We develop a probability model that accurately estimates the RR by relaxing these assumptions, and quantify their impact using a published cost-effectiveness study and also within an optimization model. These assumptions lead to inaccurate estimates in cost-effectiveness studies and to sub-optimal solutions in the optimization model. The testing solution generated by the optimization model translates into fewer expected infections without an increase in the testing cost.
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Affiliation(s)
- Ebru K Bish
- Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA 24061, USA
| | - Prasanna K Ragavan
- Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA 24061, USA
| | - Douglas R Bish
- Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA 24061, USA
| | - Anthony D Slonim
- Barnabas Health and New Jersey Medical School, University of Medicine and Dentistry of New Jersey, West Orange, NJ 07052, Newark, NJ 07103, USA
| | - Susan L Stramer
- American Red Cross, 9315 Gaither Rd., Gaithersburg, MD 20877, USA
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Shyamala V. Transfusion transmitted infections in thalassaemics: need for reappraisal of blood screening strategy in India. Transfus Med 2014; 24:79-88. [PMID: 24605952 DOI: 10.1111/tme.12110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 11/19/2013] [Accepted: 02/03/2014] [Indexed: 12/24/2022]
Abstract
The aim of the study was to assess the blood safety in India through prevalence in thalassaemic population. Safety of the blood supply is a subject of great concern for all recipients. This review attempts to assess the relevance and format of tests for viruses in the context of transfusion transmitted infection (TTI) prevalence in India. Serological marker testing for human immunodeficiency virus-1/2 (HIV-1/2), hepatitis C virus (HCV) and hepatitis B virus (HBV) is mandatory in India. Numerous TTI incidents in the repeat recipients supported by results from nucleic acid technology (NAT) testing indicate the deficiencies in blood safety. The β-thalassaemic population (3-17%) in India has been used to reflect on blood safety. The prevalence of HIV-1/2, HCV and HBV in the Indian donor population, the limitations in accessing safe donors, quality of serological tests and the impact on repeat recipients is evaluated. The reports point to prevalence of ˜2% of viral diseases in the blood donor population, and the insufficiency of serology testing resulting in up to 45% TTIs in thalassaemics. The revelation by individual donation (ID) NAT testing, of 1 per 310 units being serology negative-NAT reactive is alarming. Extrapolating the serology negative NAT reactive yields, for an annual blood supply of 7.9 million units, 23,700 units or nearly 100,000 blood components are likely to be infectious. Though the cost for ID-NAT testing is considered unaffordable for a medium development country such as India, the enormity of TTIs will place an unmanageable cost burden on the society.
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Affiliation(s)
- V Shyamala
- Research Diagnostics, Inc., Bengaluru, India
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Spending of HIV resources in Asia and Eastern Europe: systematic review reveals the need to shift funding allocations towards priority populations. J Int AIDS Soc 2014; 17:18822. [PMID: 24572053 PMCID: PMC3936108 DOI: 10.7448/ias.17.1.18822] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 01/17/2014] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION It is increasingly important to prioritize the most cost-effective HIV interventions. We sought to summarize the evidence on which types of interventions provide the best value for money in regions with concentrated HIV epidemics. METHODS We conducted a systematic review of peer-reviewed and grey literature reporting measurements of cost-effectiveness or cost-benefit for HIV/AIDS interventions in Asia and Eastern Europe. We also collated HIV/AIDS spending assessment data from case-study countries in the region. RESULTS We identified 91 studies for inclusion, 47 of which were from peer-reviewed journals. Generally, in concentrated settings, prevention of mother-to-child transmission programmes and prevention programmes targeting people who inject drugs and sex workers had lower incremental cost-effectiveness ratios than programmes aimed at the general population. The few studies evaluating programmes targeting men who have sex with men indicate moderate cost-effectiveness. Collation of prevention programme spending data from 12 countries in the region (none of which had generalized epidemics) indicated that resources for the general population/non-targeted was greater than 30% for eight countries and greater than 50% for five countries. CONCLUSIONS There is a misalignment between national spending on HIV/AIDS responses and the most affected populations across the region. In concentrated epidemics, scarce funding should be directed more towards most-at-risk populations. Reaching consensus on general principles of cost-effectiveness of programmes by epidemic settings is difficult due to inconsistent evaluation approaches. Adopting a standard costing, impact evaluation, benefits calculation, analysis and reporting framework would enable cross comparisons and improve HIV resource prioritization and allocation.
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Thachil J, Owusu-Ofori S, Bates I. Haematological Diseases in the Tropics. MANSON'S TROPICAL INFECTIOUS DISEASES 2014. [PMCID: PMC7167525 DOI: 10.1016/b978-0-7020-5101-2.00066-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Mapako T, Mvere DA, Chitiyo ME, Rusakaniko S, Postma MJ, van Hulst M. Human immunodeficiency virus prevalence, incidence, and residual transmission risk in first-time and repeat blood donations in Zimbabwe: implications on blood safety. Transfusion 2013; 53:2413-21. [PMID: 23789991 DOI: 10.1111/trf.12311] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/08/2013] [Accepted: 05/13/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND National Blood Service Zimbabwe human immunodeficiency virus (HIV) risk management strategy includes screening and discarding of first-time donations, which are collected in blood packs without an anticoagulant (dry pack). To evaluate the impact of discarding first-time donations on blood safety the HIV prevalence, incidence, and residual risk in first-time and repeat donations (wet packs) were compared. STUDY DESIGN AND METHODS Donor data from 2002 to 2010 were retrieved from a centralized national electronic donor database and retrospectively analyzed. Chi-square test was used to compare HIV prevalence with relative risk (RR), and the RR point estimates and 95% confidence interval (CI) are reported. Trend analysis was done using Cochran-Armitage trend test. HIV residual risk estimates were determined using published residual risk estimation models. RESULTS Over the 9 years the overall HIV prevalence estimates are 1.29% (n = 116,058) and 0.42% (n = 434,695) for first-time and repeat donations, respectively. The overall RR was 3.1 (95% CI, 2.9-3.3; p < 0.0001). The overall mean residual transmission risk of HIV window phase donations in first-time was 1:7384 (range, 1:11,308-1:5356) and in repeat donors it was 1:5496 (range, 1:9943-1:3347). CONCLUSION The significantly high HIV prevalence estimates recorded in first-time over repeat donations is indicative of the effectiveness of the HIV risk management strategy. However, comparable residual transmission risk estimates in first-time and repeat donors point to the need to further review the risk management strategies. Given the potential wastage of valuable resources, future studies should focus on the cost-effectiveness and utility of screening and discarding first-time donations.
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Affiliation(s)
- Tonderai Mapako
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, Netherlands; Planning, Information & Research Department, Coordination Department, Medical Services Department, National Blood Service Zimbabwe; Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe; Department of Clinical Pharmacy and Toxicology, Martini Hospital, Groningen, Netherlands
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Borkent-Raven BA, Janssen MP, van der Poel CL, Bonsel GJ, van Hout BA. Cost-effectiveness of additional blood screening tests in the Netherlands. Transfusion 2011; 52:478-88. [DOI: 10.1111/j.1537-2995.2011.03319.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bish DR, Bish EK, Xie SR, Slonim AD. Optimal selection of screening assays for infectious agents in donated blood. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/19488300.2011.609520] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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van Hulst M, Smit Sibinga CT, Postma MJ. Health economics of blood transfusion safety--focus on sub-Saharan Africa. Biologicals 2009; 38:53-8. [PMID: 20022523 DOI: 10.1016/j.biologicals.2009.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 10/23/2009] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Health economics provides a standardised methodology for valid comparisons of interventions in different fields of health care. This review discusses the health economic evaluations of strategies to enhance blood product safety in sub-Saharan Africa. METHODS We reviewed health economic methodology with special reference to cost-effectiveness analysis. We searched the literature for cost-effectiveness in blood product safety in sub-Saharan Africa. RESULT HIV-antibody screening in different settings in sub-Saharan Africa showed health gains and saved costs. Except for adding HIV-p24 screening, adding other tests such as nucleic acid amplification testing (NAT) to HIV-antibody screening displayed incremental cost-effectiveness ratios greater than the WHO/World Bank specified threshold for cost-effectiveness. The addition of HIV-p24 in combination with HCV antibody/antigen screening and multiplex (HBV, HCV and HIV) NAT in pools of 24 may also be cost-effective options for Ghana. CONCLUSIONS From a health economic viewpoint, HIV-antibody screening should always be implemented in sub-Saharan Africa. The addition of HIV-p24 antigen screening, in combination with HCV antibody/antigen screening and multiplex (HBV, HCV and HIV) NAT in pools of 24 may be feasible options for Ghana. Suggestions for future health economic evaluations of blood transfusion safety interventions in sub-Saharan Africa are: mis-transfusion, laboratory quality and donor management.
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Affiliation(s)
- Marinus van Hulst
- Unit of PharmacoEpidemiology and PharmacoEconomics (PE(2)), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
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