Safety and cost-effectiveness of solvent-detergent-treated plasma. In search of a zero-risk blood supply
J. P. AuBuchon and J. D. Birkmeyer
Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756.
OBJECTIVE--To determine the public health and economic implications of
solvent-detergent-treated frozen plasma (SD FP). While this processing
technique nearly eliminates the risk of transmitting lipid-enveloped
viruses (hepatitis B and C and human immunodeficiency virus), it has
associated costs and, because it requires pooling many plasma units, may
increase risks of nonenveloped virus transmission. DESIGN--A previously
published Markov decision analysis model was modified to assess
transfusion-related outcomes in hypothetical cohorts of plasma recipients.
In-hospital mortality and other characteristics were determined in 61
patients receiving plasma transfusions at a medium-sized tertiary care
center to provide data for the model. Other parameters were obtained from
the medical literature. MAIN OUTCOME MEASURES--Expected SD FP costs,
benefits, and cost-effectiveness, assessed as cost per quality-adjusted
life-year saved. RESULTS--Compared with untreated plasma, a unit of SD FP
produces a net benefit of 35 minutes in quality-adjusted life expectancy at
a cost of about $19. Extrapolated to the 2.2 million plasma units
transfused annually in the United States, SD FP would save 147
quality-adjusted life-years at a cost of $42.5 million. The marginal
cost-effectiveness, $289,300 per quality-adjusted life-year saved in the
baseline analysis, was most sensitive to estimates of SD treatment cost and
the clinical setting of plasma use. In sensitivity analysis, the net
benefit of SD FP was negated by the existence of even a minute risk of
nonenveloped virus infection. CONCLUSIONS--From a public health
perspective, the relatively high costs and small benefits of reducing
enveloped virus infection risks with SD FP (and the additional risks of
noneveloped virus transmission) do not appear to justify widespread
implementation of this new technology.
