In the United States, universal screening of blood donations for Zika virus was not cost-effective during the first year, according to research published in Annals of Internal Medicine.
“The Zika epidemic of the Americas beginning in 2015 remains the largest outbreak to date,” W. Alton Russell, MS, from Stanford University, and colleagues wrote. “In response, the FDA briefly discontinued blood collection in Puerto Rico in February 2016, requiring blood to be imported until universal individual donation nucleic acid testing (ID-NAT) was operationalized in March 2016.”
Today, universal screening is still required and mini-pool NAT (MP-NAT) is permitted; however, the effectiveness and cost-effectiveness of these measures is not known, according to the researchers.
Russell and colleagues sought to determine the effectiveness and cost-effectiveness of universal ID-NAT, universal MP-NAT and alternative Zika virus screening policies in the United States and Puerto Rico by simulating the costs, quality-adjusted life-years and clinical outcomes. The microsimulation detected Zika-related harms to transfusion recipients, sexual partners and their infants.
The researchers found that in the United States, none of the screening policies were cost-effective. Compared with no screening, the cost per QALY for universal ID-NAT in the United States was $341 million per QALY (95% CI, 125 million to 2.9 billion).
However, in Puerto Rico, MP-NAT was cost-effective at $81,123 per QALY (95% CI, –49,138 to 978,242), but only during high mosquito season.
In the United States, an estimated 44.7 (95% CI, 32.1-59.1) transfusion transmission cases, including mild febrile illness, Guillain–Barré syndrome and congenital Zika syndrome, would have occurred during the first year of screening if no intervention was implemented, whereas in Puerto Rico, there would have been an estimated 242.2 cases (95% CI, 194.9-291.5 cases).
Sensitivity analyses demonstrated similar results.
“Screening blood donors for Zika virus is currently not cost-effective in any jurisdiction in this study,” Russell and colleagues concluded.
In a related editorial, Katherine D. Ellingson, PhD, from the University of Arizona, and Matthew J. Kuehnert, MD, from MTF Biologics, wrote that the study by Russell and colleagues was well-executed.
The study “provides a platform for discussing tradeoffs in concrete terms and in light of current — although imperfect — knowledge,” they wrote. “This perspective can be helpful in decisions about blood safety, which remain intensified by public fear and scientific uncertainty.” – by Alaina Tedesco
Disclosures: Ellingson and Kuehnert report no relevant financial disclosures. Russell reports receiving personal fees from Terumo BCT. Please see study for all other authors’ relevant financial disclosures.