196764 Preventing Transmission of Chagas Disease in the U.S. Blood Supply: A Cost-Effectiveness Analysis of Testing Blood Bank Donations

Monday, November 9, 2009

Danielle Doughman, MSPH , Dept of Health Policy, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
Background: Chagas Disease is a parasitic infection that affects people living in poor, rural areas of the Americas. Though Chagas is not endemic to the U.S., increased attention on immigration from Latin America to the U.S. coupled with the availability of a highly effective assay highlight the need for testing of the blood donations for Chagas, which may be transmitted through transfusion. Currently, blood banks are not required to test for Chagas.

Methods: To estimate incremental cost-effectiveness of blood bank testing and screening strategies for Chagas, a cost-effectiveness analysis with a decision tree model with a 20-year time horizon is used. Data is taken from peer-reviewed literature. The interventions include: 1) testing all blood donations, 2) verbal screen with ELISA testing for those with a positive screen, and 3) testing new donors only. Base-case and sensitivity analyses are conducted.

Results: In the base-case analysis, Test All averted 20 additional cases over Screen and Test, but at a cost of $3.6 million per additional case averted. Test New Donors resulted in an additional 14 disease cases compared to Screen and Test and with had the lowest costs of all alternatives. The sensitivity analysis is most sensitive to whether or not a negative verbal screen was obtained and slightly sensitive to the probability for high risk of transmission.

Conclusion: Both Screen and Test and Test All improve over the standard of Test New Donors in the number of cases averted, however, both are cost-prohibitive at thresholds of $1 million per case averted.

Learning Objectives:
1. Describe Chagas disease transmission and progression 2. Identify three methods for testing the blood supply for Chagas disease 3. Compare disease and cost outcomes for each of the three testing alternatives

Keywords: Infectious Diseases, Cost Issues

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I worked closely with my faculty advisor to develop the research and earned the equivalent of an A on the work, indicating that the methods, results and interpretation are sound.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.