Screening for human T cell leukaemia/lymphoma virus among blood donors in Sweden: cost effectiveness analysis
Abstract Objective: To analyse the cost effectiveness of a national programme to screen blood donors for infection with the human T cell leukaemia/lymphoma virus. Design: Three models for calculating the costs and benefits of screening were developed. The first model analysed the cost of continuousl...
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| Published in: | BMJ Vol. 316; no. 7142; pp. 1417 - 1422 |
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| Main Authors: | , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
England
British Medical Journal Publishing Group
09-05-1998
British Medical Association BMJ Publishing Group LTD British Medical Journal |
| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Abstract Objective: To analyse the cost effectiveness of a national programme to screen blood donors for infection with the human T cell leukaemia/lymphoma virus. Design: Three models for calculating the costs and benefits of screening were developed. The first model analysed the cost of continuously testing all donations; the second analysed the cost of initially testing new blood donors and then retesting them after five years; the third analysed the cost of testing donors only at the time of their first donation. Patients who had received blood components from donors confirmed to be infected with the virus were offered testing. Setting: Sweden. Main outcome measures: Prevalence of infection with the virus among blood donors, the risk of transmission of the virus, screening costs, and the outcome of infection. Results: 648 497 donations were tested for the virus; 1625 samples tested positive by enzyme linked immunosorbent assay. 6 were confirmed positive by western blotting. The prevalence of infection with the virus was 2/100 000 donors. 35 patients who had received blood infected with the virus were tested; 3 were positive. The cost of testing every donation was calculated to be $3.02m (£1.88m); this is 18 times higher than the cost of testing new donors only, and only 1 additional positive donor would be discovered in 7 years. Regardless of the model used, screening was estimated to prevent only 1 death every 200 years at a minimum cost of $36m (£22.5m). Conclusion: Based on these estimates the Swedish National Board of Health and Welfare decided that only new blood donors would be screened for infection with the virus. Key messages The human T cell leukaemia/lymphoma virus is primarily sexually transmitted; it may also be transmitted through blood transfusions Infection with the virus may cause adult T cell leukaemia/lymphoma or tropical spastic paraparesis Many countries including Sweden have begun screening blood donors for the virus; however a low prevalence of infection in non-endemic areas a low risk of developing adult T cell leukaemia/lymphoma in people infected with the virus a long incubation period and the older age of most transfusion recipients make screening costly Three models of screening were compared: testing every donation, testing new donors and then retesting them after five years, and testing new donors only Regardless of the model used screening in Sweden would only prevent one death every 200 years at a minimum cost of $36m (£22.5m) |
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| Bibliography: | Correspondence to: Dr Tynell istex:C7873A8569A26E14ACFFF9A6FD3D0BEADDEE759F ark:/67375/NVC-8ZMNBZRX-2 local:bmj;316/7142/1417 PMID:9572750 href:bmj-316-1417.pdf ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Contributors: ET coordinated and performed most of the study, especially the final compilation and analysis of data. AB acted as a consultant to the national screening programme, assisted in the analysis of data, initiated the development of the cost effectiveness models, and is guarantor for the paper. SA was responsible for the polymerase chain reaction analysis and developing the guidelines, evaluation and analysis of the laboratory screening. MA coordinated the compilation of all data on blood screening. KR coordinated the tracing of transfusion recipients who had received infected blood. EL was instrumental in developing the structure of the national screening programme. JB conducted the pilot study. HBH directed the pilot study and was responsible for tracing the recipients of infected blood. AK assisted in compiling clinical data on donors infected with the virus. MN assisted with the pilot study. AS contributed to the discussion on the principles of blood transfusion. The paper was written by ET, SA, and AB. Correspondence to: Dr Tynell elsa.tynell@inf.ds.sll.se |
| ISSN: | 0959-8138 1468-5833 1756-1833 |
| DOI: | 10.1136/bmj.316.7142.1417 |