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.