SCREENING FOR HUMAN T-CELL LEUKAEMIA LYMPHOMA VIRUS AMONG BLOOD-DONORS IN SWEDEN - COST-EFFECTIVENESS ANALYSIS/

Objective: To analyse the cost effectiveness of a national programme t o screen blood donors for infection with the human T cell leukaemia/ly mphoma virus. Design: Three models for calculating the costs and benef its of screening were developed. The first model analysed the cost of continuously testing all donations; the second analysed the cost of in itially testing nerv blood dollars and then retesting them after five years; the third analysed the cost of testing donors only at the time of their first donation, Patients who had received blood components fr om donors confirmed to be infected with the virus were offered testing . Setting: Sweden. Main outcome measures: Prevalence of infection with the virus among blood donors, the risk of transmission of the virus, screening costs, and the outcome of infection. Results: 648 497 donati ons were tested for the virus; 1625 samples tested positive by enzyme linked immunosorbent assay, 6 were confirmed positive by western blott ing. The prevalence of infection with the virus was 2/100 000 donors. 35 patients who had received blood infected with the virus were tested ; 3 were positive. The cost of testing every donation was calculated t o be $3.02m (pound 1.88m); this is 18 times higher than the cost of te sting new donors only, and only 1 additional positive donor would be d iscovered in 7 years. Regardless of the model used, screening was esti mated to prevent only 1 death every 200 years at a minimum cost of $36 m (pound 22.5m). Conclusion: Based on these estimates the Swedish Nati onal Board of Health and Welfare decided that only new blood donors wo uld be screened for infection with the virus.