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Am. J. Trop. Med. Hyg., 79(1), 2008, pp. 53-68
Copyright © 2008 by The American Society of Tropical Medicine and Hygiene

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Cost-effectiveness of Implementation Methods for ELISA Serology Testing of Trypanosoma cruzi in California Blood Banks

Leslie S. Wilson*, Janine M. Ramsey, Yelena B. Koplowicz, Leopoldo Valiente-Banuet, Christi Motter, Stefano M. Bertozzi, AND Leslie H. Tobler
University of California, San Francisco, California; Area de Estructura Centro de Investigaciones de Paludismo Instituto Nacional de Salud Publica, Calle Poniente Tapachula, Chiapas, Mexico; National Blood Transfusion Center, Gustavo A. Madero Mexico City, Mexico; Division of Health Economics and Policy National Institute of Public Health Cuernavaca, Mexico; Viral Reference Laboratory and Repository Core Blood Systems Research Institute, San Francisco, California

The first U.S. ELISA test for T. cruzi antibodies was licensed by the Food and Drug Administration (FDA) on December 13, 2006. Blood banks have begun screening in absence of FDA recommendations for best implementation methods. We surveyed 2,029 blood donors at five California sites with three risk-based Chagas risk-screening questions. Semi-Markov models compared the cost-effectiveness of three testing strategies. 30% of donors screened positively. Screening all dominated doing nothing, being less costly, and saving more lives. The choice to "screen and test" compared with "testing all" varied by Chagas prevalence, "screening and testing" being cost-effective for high (0.004) and low (0.00004) prevalences, and "testing all" cost-effective for moderate risk (0.0004). It is cost-effective to screen by ELISA rather than do nothing. The best strategy depends on site-specific risk. Census estimates of Hispanics do not predict donor risk well. We suggest using our screening questions to determine risk level and most cost-effective testing strategy.

Received October 1, 2007. Accepted for publication April 8, 2008.

Acknowledgments: The authors very gratefully acknowledge Dr. David Oh, Dr. Kim-Ahn Nguyen, Dr. Nora Hirschler, and Dr. Patricia Kopko at the American Blood Bank Sites who assisted us with survey data collection and also all blood donors answering our survey. We also thank Dr. Michael Busch and Dr. Brian Custer from the Blood Systems Research Institute for their helpful suggestions, expert advice, and data estimates.

Financial support was received from UC-MEXUS Programma de Investigacion en Migracion y Salud (PIMSA).

* Address correspondence to Leslie S. Wilson, Associate Adjunct Professor, University of California, San Francisco, 3333 California Street, Suite 420, Box 0613, San Francisco, CA 94010-0613. E-mail: wilsonL{at}pharmacy.ucsf.edu

Authors’ addresses: Leslie S. Wilson, Associate Adjunct Professor, University of California, San Francisco, 3333 California Street, Suite 420, Box 0613, San Francisco, CA 94010-0613, Tel: 415-502-5092, Fax: 415-502-0792, E-mail: wilsonL{at}pharmacy.ucsf.edu. Janine M. Ramsey, Director de Area de Estructura Centro de Investigaciones de Paludismo Instituto Nacional de Salud Publica, 4ta Av. Nte esq 19 Calle Poniente Tapachula, Chiapas, 30700 Mexico, Tel: 52-962-625-0800, Fax: 52-962-628-5782, E-mail: jramsey{at}insp.mx. Yelena B. Koplowicz, Resident, University of California, San Francisco, 3333 California Street, San Francisco, CA 94010, Tel: 415-502-5092, Fax: 415-502-0792. Leopoldo Valiente-Banuet, MC Medical Sciences Scientist B, CNTS, National Blood Transfusion Center, Av. Othon de Mendizabal 195 Col Zacatenco Del Gustavo A. Madero, Mexico City, Mexico DF 07360, Tel: 001-52-51194620 – 28 ext. 1408, E-mail: lvaliente{at}gmail.com. Christi Motter, Candidate, University of California, San Francisco, 3333 California Street, San Francisco, CA 94010, Tel: 415-502-5092, Fax: 415-502-0792. Stefano M. Bertozzi, Director, Division of Health Economics and Policy, National Institute of Public Health, Cuernavaca, Mexico, E-mail: sbertozzi{at}correo.insp.mx. Leslie H. Tobler, Senior Scientist, Viral Reference Laboratory and Repository Core Blood Systems Research Institute, 270 Masonic Ave., San Francisco, CA 94118, Tel: 415-749-6609, Fax: 415-775-3859, E-mail: ltobler{at}bloodsystems.org.




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