Modelling the risk of transfusion-transmitted syphilis: a reconsideration of blood donation testing strategies.
Vox Sang
; 114(2): 107-116, 2019 Feb.
Article
in En
| MEDLINE
| ID: mdl-30565234
ABSTRACT
BACKGROUND AND OBJECTIVES:
Donor syphilis testing began in the 1940s amidst widespread transfusion-transmitted syphilis (TTS). Since then, the introduction of penicillin, pre-donation screening questionnaires and improved storage conditions have contributed to reducing transmission risk. Consequently, universal testing may no longer be cost-effective. This study analysed alternative options for donor syphilis testing to determine the optimal strategy. MATERIALS ANDMETHODS:
A model was developed using conservative parameter estimates for factors affecting TTS and 2009-2015 Australian donations to calculate risk outcomes (TTS infections, tertiary syphilis in recipients and transfusion-associated congenital syphilis) and cost-effectiveness of alternative testing strategies. The strategies modelled were as follows universal testing, targeted-testing of high-risk groups (males ≤50 years old and first-time donors) and no testing.RESULTS:
The estimated risk of TTS is one in 49·5 million transfusions for universal testing, one in 6 million for targeted-testing of males ≤50 years old, one in 4 million for targeted-testing of first-time donors and one in 2·8 million for no testing. For all strategies, the risk of tertiary and congenital syphilis is <1 in 100 million. Universal testing is the least cost-effective strategy with an incremental cost-effectiveness ratio (ICER) estimated at $538·5 million per disability-adjusted life year averted.CONCLUSION:
Universal testing is not required to maintain the risk of TTS within tolerable limits and is estimated to greatly exceed acceptable ICERs for blood safety interventions. However, despite a strong economic and risk-based rationale, given the epidemiology of syphilis in Australia is changing, feedback from critical stakeholders is not currently supportive of reducing testing.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Serologic Tests
/
Syphilis
/
Blood Safety
/
Transfusion Reaction
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Aspects:
Patient_preference
Limits:
Humans
/
Male
/
Middle aged
Country/Region as subject:
Oceania
Language:
En
Journal:
Vox Sang
Year:
2019
Document type:
Article
Affiliation country:
Australia