A cost-effectiveness analysis of screening strategies for human immunodeficiency virus in donated blood in France.

Background - The residual risk of human immunodeficiency virus (HIV) infect ion from screened blood transfusion was estimated to be 1.7/10(6) between 1 993 and 1995 in France. To orient blood safety policies, we have evaluated what would be, from the perspective of blood banks, the best screening stra tegy in terms of gain in effectiveness and added costs. Methods - A cost-effectiveness analysis compared 20 HIV-testing protocols u sing (1) available data for performances of the current screening tests; an d, (2) national insurance estimates for the cost of tests. Results were exp ressed as the number of false negative donations that would be avoided and the cost by avoided false negative donation. Results - For 3 million donated blood units a year and a prevalence of 24 p er million, there would be 72 infectious donated blood units, 70.56 of whic h would be detected by the current screening strategy. The number of additi onal donated blood infections avoided in all other strategies would be low (between 0.25 and 1.28) with a very high cost (280 million French francs pe r added false negative avoided or more). Conclusion - A change in screening strategies for blood donations in France is not currently justified. If such a change was to be done, adding p24 an tigen detection to the current screening strategy would be one of the worst solutions. (C) 1999 Elsevier, Paris.