Policy and Health Economic Analyses

Example of Recent Work
In 2016, universal individual donation nucleic acid testing (ID-NAT) of donated blood for Zika virus began in the US states and territories. We conducted a study to assess the cost-effectiveness of ID-NAT screening compared with alternatives for the 50 states and separately for Puerto Rico. Microsimulation modeling including Zika-related risks to transfusion recipients, sexual partners, and their infants. A range of interventions were evaluated: Universal ID-NAT, universal mini-pool NAT (MP-NAT), and ID-NAT exclusively for components transfused to women of childbearing age, seasonally targeted strategies in Puerto Rico and geographically targeted strategies in the 50 states were also considered. In Puerto Rico, MP-NAT exclusively during high mosquito season was cost-effective at $81,000 per Quality-Adjusted Life Year (QALY) gained. In the 50 states, universal ID-NAT cost $341 million/QALY, and the current policy of MP-NAT screening cost $210 million/QALY when compared no screening. Even at a threshold of $1million/QALY, no evaluated policy was cost-effective in the 50 states. During periods with lower rates of Zika-infectious donations, as has been the situation in the years 2017 – 2019, the cost-effectiveness of screening will be even less favorable.

Selected Publications:

Custer B, Zou S, Glynn SA, Makani J, Tayou Tagny C, El Ekiaby M, Sabino EC, Choudhury N, Teo D, Nelson K, Peprah E, Price L, Engelgau MM. Addressing gaps in international blood availability and transfusion safety in low- and middle-income countries: a NHLBI workshop. Transfusion. 2018 May;58(5):1307-1317. doi: 10.1111/trf.14598. Epub 2018 Mar 14. Review.

Russell WA, Stramer SL, Busch MP, Custer B. Screening the Blood Supply for Zika Virus in the 50 U.S. States and Puerto Rico: A Cost-Effectiveness Analysis. Ann Intern Med. 2019 Feb 5;170(3):164-174. doi: 10.7326/M18-2238. Epub 2019 Jan 8.

Vermeulen M, van den Berg K, Sykes W, Reddy R, Ingram C, Poole C, Custer B. Health economic implications of testing blood donors in South Africa for HTLV 1 & 2 infection. Vox Sang. 2019 Jul;114(5):467-477. doi: 10.1111/vox.12788. Epub 2019 May 26. PMID: 31131453