SCREENING BLOOD-DONORS FOR HEREDITARY HEMOCHROMATOSIS - DECISION-ANALYSIS MODEL-BASED ON A 30-YEAR DATABASE

Background & Aims: The high prevalence, morbidity, premature death, an d benefit of early diagnosis and treatment make hemochromatosis a prim e target for screening in the white population. Decision analysis tech niques were used to compare the outcome, utility, and incremental cost savings of a plan to screen voluntary blood donors for hemochromatosi s. Methods: The screening strategy includes sequential testing of seru m unsaturated iron-binding capacity, serum transferrin saturation, ser um ferritin, and either hepatic iron index or venesections to measure exchangeable body iron. Estimates of prevalence, asymptomatic interval s, probabilities of life-threatening clinical complications, symptom-s pecific life expectancy, and sensitivity and specificity of screening tests are based on our database of 170 hemochromatosis homozygotes and the published literature. Results: The screening strategy led to an i ncremental increase in utility of 0.84 quality-adjusted life days with an incremental cost savings of $3.19 per blood donor screened. When t he potential of identifying asymptomatic homozygous siblings was inclu ded, these values increased to 1.18 quality-adjusted life days and $12 .57 per person screened. Screening remained a dominant strategy given a prevalence of hemochromatosis of >0.0026 or an initial screening tes t cost of <$8. Conclusions: Screening blood donors for hemochromatosis has the potential to improve overall societal health status and decre ase third-party payer health care costs over the long-term.