A model of the health and economic impact of posttransfusion hepatitis C: application to cost-effectiveness analysis of further expansion of HCV screening protocols

BACKGROUND: Cost-effectiveness analyses are needed to decide the value of f urther expansion of the screening protocols for HCV in blood donors. Howeve r, such analyses are hampered by imperfect knowledge of the health and econ omic repercussions of posttransfusion hepatitis C (PTHC). STUDY DESIGN AND METHODS: A Monte Carlo simulation of a Markov model repres enting the outcomes of patients transfused with HCV-infective blood was use d to estimate the health and economic impact of PTHC and to calculate the c ost-effectiveness ratio of various HCV screening methods. RESULTS: Median survival for hypothetical patients with PTHC and for contro ls without hepatitis was 11.25 and 11.75 years, respectively. Overall, 12.3 percent of patients receiving HCV-infective blood will develop chronic hep atitis, 9.3 percent will progress to liver failure, and 9.25 percent will e ventually die of liver disease after a median time of 20.75 years (range, 6 -70). Ninety-one percent of the infected blood recipients had no reduction in life expectancy due to PTHC, and the average loss per patient was 0.754 years. The present value of the lifetime health costs incurred by patients with PTC is $6330 per case. HCV antibody testing increases the patients' li fe expectancy by 20.4 hours per blood collection tested, and it results in net savings by decreasing the number of patients that will require treatmen t for liver disease in the future. Adding HCV NAT increases the patients' l ife expectancy by 0.08 hours per blood collection tested, at a cost-effecti veness ratio of $1,829,611 per QALY gained. CONCLUSION: PTHC has low health benefits because of the advanced age of man y blood recipients. Testing donors for HCV antibodies results in net saving s for the health care system, despite low health benefits. Adding HCV NAT w ould produce little additional gain at a very high cost.