An assessment of the risk, cost-effectiveness, and perceived benefits of anti-parvovirus B19 tested blood products.

BACKGROUND: Parvovirus B19 (B19V) can cause severe anemia, hydrops foetalis, and even death in vulnerable patients. To prevent transfusion-transmitted B19V infection of at-risk patients, B19V antibody screening of blood donors was implemented. The cost-effectiveness of this intervention is unclear, as the likelihood of transmission through blood and subsequent complications for recipients are unknown. This study estimates the cost-effectiveness of anti-B19V donor screening in the Netherlands. STUDY DESIGN AND METHODS: The estimates needed for the cost-effectiveness model were: the occurrence of B19V in Dutch blood donors, the number of anti-B19V tested products required by hospitals, the likelihood of morbidity and mortality given B19V infection, treatment costs, and screening costs. These estimates were obtained from literature and observational data. When data were unavailable, structured expert judgment elicitation and statistical modeling were applied. RESULTS: The costs of preventing one transfusion transmitted B19V infection are estimated at €68,942 (€42,045 - €102,080). On average, 1.25 cases of morbidity and 0.12 cases of mortality are prevented annually. Although the perceived risk of transfusion transmitted B19V infection was low, half of the treating physicians favored anti-B19V screening. CONCLUSION: The estimated mortality and morbidity caused by B19V infection was low in the risk groups. The cost-effectiveness ratio is similar to other blood safety screening measures. No guidance exists to evaluate the acceptability of this ratio. The explicit overview of costs and effects may further guide the discussion of the desirability of B19V safe blood products.

The geographic distribution and financial impact of canine parvovirus in Australia.

Canine parvovirus (CPV) is an important cause of serious and often fatal disease in dogs worldwide, however, a national survey of CPV cases in Australia has not been conducted since 1982. For this study we surveyed the entire Australian veterinary clinic population and achieved a response rate of 23.5% (534 unique veterinary clinics). Respondents reported 4,451 CPV cases in 2015 and 4,219 cases in 2016; the estimated total CPV case load across Australia was 20,661 in 2015 and 20,110 in 2016. The overall reported euthanasia rate was 41%. Geospatial analysis revealed large numbers of CPV cases in rural and remote areas of Australia. Where cases occurred in capital city areas, these were found in peri-urban areas, away from the inner city. The median cost to treat CPV cases was $A1,500 per patient. A significant difference in the cost of treating cases was found between Australian states; Western Australia (median $A2,500) was the most expensive state. There was a strong correlation between cost of treatment and rate of euthanasia without treatment reflecting the important role of affordability in disease-related euthanasia. These findings highlight the considerable impact of the evolving CPV situation in Australia, particularly in regional and rural areas. This survey is the most comprehensive epidemiological investigation of canine parvoviral-related disease, to date, globally and provides a process for national disease surveillance.

[Parvovirus B-19 infections in pregnant women in day care facilities: health economic analysis of prohibition to employ seronegative women]. / Parvovirus-B19-Infektionen bei Schwangeren in der Kinderbetreuung. Gesundheitsökonomische Analyse eines Beschäftigungsverbots.

German protective legislation during pregnancy and maternity prohibit employing pregnant women if occupational activities endanger the health of either the mother-to-be or the fetus. This applies for parvovirus B19 seronegative women caring for children <6 years. Here we present a cost-effectiveness analysis from the view of the society for the prohibition to employ B19-seronegative women in day care. Prohibition of employment starting at the first day of pregnancy may prevent 1.4 cases of fetal death (mortality) and 1.7 cases of hydrops fetalis (morbidity) per year resulting in costs of 30 million (22 million /live birth). The incidence of B19 infection, the elevated occupational risk and the fetal death rate were varied in sensitivity analyses. This resulted in 0.2-3.1 fetal deaths prevented per year and costs between 10 million and 150 million per live birth. Indeed, the protective effect is assumed to be even lower since 30% of fetal deaths occur after infection during the first 8 weeks of pregnancy. During that time prohibition of employment is often unrealistic since the majority of women are not aware of pregnancy. In conclusion a small number of fetal lives can be saved by prohibiting employment in contrast to the extremely high costs. The regulations for maternal protection should be revised.

Financial evaluation of vaccination and testing alternatives for control of parvovirus-induced reproductive failure in swine.

OBJECTIVE: To identify the preferable testing and vaccination strategy for control of porcine parvovirus (PPV) during a 6-month period. DESIGN: Decision-tree analysis and computer simulations. SAMPLE POPULATION: Computer modeling of 300-sow farrow-to-finish herd. PROCEDURE: Serologic testing of 30 females to estimate herd PPV prevalence versus not testing any females was the initial decision alternative. On the basis of serologic test results, herds were classified into 1 of 3 PPV-risk categories: low (> or = 80% seropositive females), moderate (40 to < 80% seropositive females), or high (< 40% seropositive females). Vaccinating all females, only gilts, or not vaccinating was the second decision alternative. RESULTS: For initial model assumptions (test sensitivity and specificity = 0.95; test cost = $5/female; vaccination cost = $0.30/dose; vaccination efficacy = 0.95; and foregone gross margin = $10.85/pig), vaccination of all females (with or without serologic testing) was preferable, but the financially preferable option was to omit serologic testing. Most profitable vaccination option varied with foregone gross margin, vaccination cost, and efficacy. For herds in which all sows were known to be immune, vaccinating only gilts was financially preferable, and serologic testing was not warranted. Variation is expected monetary losses was less in vaccination options than with nonvaccination. CLINICAL IMPLICATIONS: For most herds in the United States, serologic screening for PPV prior to selection of a vaccination program is unlikely to be cost-effective, because vaccination is inexpensive ($0.30/dose) and effective (95%). At current profit margins ($10.85/pig), vaccination of all females has the least-risk and is the preferred option.

An economic assessment of porcine parvovirus vaccination.

A decision analysis model was designed to evaluate the cost effectiveness of a vaccination program for preventing endemic or epidemic porcine parvovirus (PPV) induced reproductive failure in a 100-sow pig herd. The results showed that the cost of vaccination was less than the cost incurred by continuing endemic PPV infection, or the cost of a severe epidemic. A long term vaccination program is a cost effective method for controlling PPV-induced reproductive failure in pig herds suffering endemic and epidemic PPV infection.