2014/LSIF/PD/030 Risk Assessment and Cost-Effectiveness of Blood Safety Interventions for HIV, HCV, and HBV Development of a Web-Based Application

Size: px

Start display at page:

Download "2014/LSIF/PD/030 Risk Assessment and Cost-Effectiveness of Blood Safety Interventions for HIV, HCV, and HBV Development of a Web-Based Application"

Jodie Wilkinson
6 years ago
Views:

Submitted by: Blood Systems Research Institute (BSRI) Policy Dialogue and Workshop

1 2014/LSIF/PD/030 Risk Assessment and Cost-Effectiveness of Blood Safety Interventions for HIV, HCV, and HBV Development of a Web-Based Application Submitted by: Blood Systems Research Institute (BSRI) Policy Dialogue and Workshop on Attaining a Safe and Sustainable Blood Supply Chain Manila, Philippines 30 September 1 October 2014

2 Risk assessment and cost-effectiveness of blood safety interventions for HIV, HCV, and HBV Development of a web-based application APEC Policy Dialogue and Workshop on Attaining a Safe and Sustainable Blood Supply Chain Brian Custer, PhD, MPH Epidemiology and Health Policy Research bcuster@bloodsystems.org October 1, 2014 Manila, Philippines

3 Objectives Bring together experts in transfusion-transmitted infections and health technology assessment Enhance the knowledge of and use of risk assessment, economic analysis and modeling methods in blood safety and transfusion community Develop analysis tools that are readily accessible for others to use Improve country-to-country comparisons with common underlying models and analysis assumptions Conduct specific analyses that demonstrate the capabilities on contributions of cost utility analyses to decision making 2 Project funded by the ISBT TTID Working Party

4 Rationale A one size fits all approach to selecting blood safety interventions for each economy/setting will not work Appropriate blood screening interventions will depend on: Development status of a country s blood banking and transfusion service programs Prevalence and incidence of each transfusion-transmissible infection Available human and laboratory resources and expertise Available healthcare budget for blood safety Different combinations of donor selection, serological testing, nucleic acid testing, and other technologies may be appropriate in different settings 3

5 Role and Purpose The role of this project is not to say whether an intervention is cost-effective rather it is to provide tools and conduct rigorous analyses Provide technical expertise to decision makers in diverse settings Assist in analyses when requested 4

6 Current Projects A six country analysis of a range of HDI countries: Brazil, Ghana, Netherlands South Africa, Thailand, USA Assessment of tool capabilities An eight country analysis of high HDI countries: Australia, Canada, Denmark, Finland, France, Netherlands, UK, USA Consistent or inconsistent patterns of economic acceptability

7 Steps in Analysis/Required Data 1. Selection of risk model, donor testing data 2. Recipient/patient epidemiology 3. Infectious window periods by assay 4. Donation screening costs 5. Methodological aspects of the analysis (health economic factors) 6. HIV disease progression and treatment costs 7. HBV and HCV disease progression 8. HBV and HCV treatment costs 9. Results of Analysis 6 Includes comparison of results to 3x GNI (GDP) threshold for cost-effectiveness

8 Results Reporting 1. Infections remaining, total costs (testing and disease treatment) and Quality Adjusted Life Years (QALYs) gained A Disability Adjusted Life Years (DALYs) version is also available 2. Incremental cost effectiveness ratios (ICERs) 3. Cost-effectiveness plane, also known as the Efficiency Frontier Save and Download report 7

9 Quadrants of the Cost Effectiveness Plane 8 Kacker Transfusion 2013

13 Results - Brazil Screening Strategies Remaining HIV Infections Remaining HCV Infections Remaining HBV Infections Total Costs (USD) QALYs Gained No Screening ,244, HIV Ab + HCV Ab + HBsAg ,866, HIV Combo + HCV Combo + HBsAg ,781, All Mini Pool (x) Multiplex NAT ,319, All Individual Donation Multiplex NAT ,304,

14 Preliminary Results for Six Countries

15 Interpreting Results Strategies indicated by the word Dominant in the results table are more effective and/or less costly to the overall healthcare system when considering the cost of testing offset by the avoided costs of transfusiontransmitted infections. The cost-effectiveness is strongly influenced by the order of implementation and (combination) of tests actually in place. Results indicate that in any setting the use of serology assays is very cost-effective or even cost saving. NAT has varying cost-utility depending on the setting, and independent of serology is relatively cost-effective.

16 Acknowledgments ISBT TTID Working Party Mart Janssen Mike Busch Silvano Wendel Ravi Reddy JP Allain Cees van der Poel (Honorary) Other collaborators Rene van Hulst Gijs Hubben Marion Vermeulen Ester Sabino Maria Agapova ABO RBDM Project Judie Leach Bennett Sheila Ward Jay Menitove Peter McDonald Peter Tomasulo Tina Viner

17 Thank you for your attention Please feel free to contact me if you are interested in the ISBT TTID CUA Tool or have questions about it.

18 Extra Slides

Risk Based Decision Making Project Health Economic and Outcomes Objective: To compare the cost-utility of the same interventions in a list of countries with similar HDIs Participants: Australia,

22 Risk Based Decision Making Project Health Economic and Outcomes Objective: To compare the cost-utility of the same interventions in a list of countries with similar HDIs Participants: Australia, Canada, Denmark, Finland, France, Netherlands, UK, USA Are patterns of similar cost-effectiveness/utility ratios evident? What aspects may exhibit substantial differences? Are there broader patterns with respect to blood safety for HIV, HBV, and HCV that can be discerned?

2014/LSIF/PD/025 Malaysia s Approach to Testing Strategies

2014/LSIF/PD/025 Malaysia s Approach to Testing Strategies Submitted by: Malaysia Policy Dialogue and Workshop on Attaining a Safe and Sustainable Blood Supply Chain Manila, Philippines 30 September 1