Cost-effectiveness of questionnaires in preventing transfusion-transmitted infections.

Background: The cost-effectiveness of the donor health questionnaire (DHQ) as a tool to assess donor eligibility has not been quantified. This study focused on cost-effectiveness of the DHQ in preventing transfusion-transmitted infections (TTIs).

Study Design And Methods: Data on whole blood donor eligibility assessments in the Netherlands in 2008 to 2010 were analyzed. Based on test results and epidemiologic data on TTIs, the number of donor visits in their window phase was calculated. Subsequently, the incremental cost-effectiveness ratio (ICER) of the DHQ was calculated.

Results: The overall annual deferral rate in the study period was 9.6% (9.3%-10.0%). The annual deferral rate for TTI risk was 0.86% (0.82%-0.89%). Taking into account the number of self-deferrals, deferral rate for TTI risk in all donors was 1.90% (1.81%-2.02%). The calculated annual numbers of prevented cases of TTI were hepatitis B, 0.142; hepatitis C, 0.010; human immunodeficiency virus, 0.016; and syphilis, 0.135. The annual costs for TTI risk-related eligibility assessments, deferrals, and substitutions were €84,807 (€55,193-€123,811) for the blood establishment (BE) and €90,501 (€46,965-€159,571) for deferred donors. Annual savings were €991 (€276-€2325), while annual quality-adjusted life-years (QALYs) gained were 0.120 (0.059-0.226). Hence, the ICER for the DHQ on preventing TTIs was €696,744 (€315,422-€1,611,681) for BE costs only and €1,449,055 (€669,439-€3,145,961) including costs for deferred donors.

Conclusion: The DHQ enhances self-selection and should not be abandoned. However, the DHQ is not a cost-effective tool for further reducing TTIs. The high costs per case prevented and the small number of QALYs gained argue against maintaining deferral policy through the DHQ at the current level.