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Use of a Decision Support System

J. Sanford Schwartz, MD; Bruce P. Kinosian, MD; William P. Pierskalla, PhD; Hau Lee, PhD

JAMA. 1990;264(13):1704-1710.

Abstract
A decision analytic model was used to examine alternative strategies to screen donated blood for human immunodeficiency virus (HIV) using data from the literature and from 1987 blood-screening programs in areas with high and low prevalence of HIV. Sensitivity analyses incorporated uncertainties about HIV infection and test performance. Current screening strategies are estimated to allow 20.5 infected units per million donated units to be transfused at a cost of $16 850 per HIV-positive unit detected in high-prevalence areas and 4.7 infected units per million donated units to be transfused at a cost of $32 275 per HIV-positive unit detected in low prevalence areas, with nine false-positive notifications of uninfected patients per million units screened and 14.9 discarded, noninfected units per HIV-positive unit in low-prevalence areas. Testing donated blood for HIV can be improved by individualizing screening strategies for areas with different prevalences of HIV. Efforts to further reduce transfusion-associated HIV should focus on improved test performance in early stages of infection, reduction of unnecessary transfusions, donor recruitment in lower-risk groups, and public health measures to reduce HIV infection among the general population.

(JAMA. 1990;264:1704-1710)

Author Affiliations
From the Section of General Internal Medicine and Clinical Epidemiology Unit, Department of Medicine (Drs Schwartz and Kinosian), the Leonard Davis Institute of Health Economics (Drs Schwartz, Kinosian, and Pierskalla), and the Department of Health Care Administration (Drs Schwartz and Pierskalla) and the Department of Decision Sciences, Wharton School of Management (Dr Pierskalla), University of Pennsylvania, Philadelphia; the Division of Geriatrics, Medical Service, Philadelphia (Pa) Veterans Administration Medical Center (Dr Kinosian); and the Department of Industrial Engineering and Engineering Management, Stanford (Calif) University (Dr Lee).

Footnotes
Reprint requests to Leonard Davis Institute of Health Economics, 3641 Locust Walk, Philadelphia, PA 19104 (Dr Schwartz).

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