Modelling the risk of transfusion-transmitted syphilis: a reconsideration of blood donation testing strategies

Thisuri Jayawardena, Veronica Hoad, Claire Styles, Clive Seed, Peter Bentley, Vanessa Clifford, Sarina Lacey, Tessa Gastrell

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background and Objectives: Donor syphilis testing began in the 1940s amidst widespread transfusion-transmitted syphilis (TTS). Since then, the introduction of penicillin, pre-donation screening questionnaires and improved storage conditions have contributed to reducing transmission risk. Consequently, universal testing may no longer be cost-effective. This study analysed alternative options for donor syphilis testing to determine the optimal strategy. Materials and Methods: A model was developed using conservative parameter estimates for factors affecting TTS and 2009-2015 Australian donations to calculate risk outcomes (TTS infections, tertiary syphilis in recipients and transfusion-associated congenital syphilis) and cost-effectiveness of alternative testing strategies. The strategies modelled were as follows: universal testing, targeted-testing of high-risk groups (males ≤50 years old and first-time donors) and no testing. Results: The estimated risk of TTS is one in 49·5 million transfusions for universal testing, one in 6 million for targeted-testing of males ≤50 years old, one in 4 million for targeted-testing of first-time donors and one in 2·8 million for no testing. For all strategies, the risk of tertiary and congenital syphilis is <1 in 100 million. Universal testing is the least cost-effective strategy with an incremental cost-effectiveness ratio (ICER) estimated at $538·5 million per disability-adjusted life year averted. Conclusion: Universal testing is not required to maintain the risk of TTS within tolerable limits and is estimated to greatly exceed acceptable ICERs for blood safety interventions. However, despite a strong economic and risk-based rationale, given the epidemiology of syphilis in Australia is changing, feedback from critical stakeholders is not currently supportive of reducing testing.

Original languageEnglish
Pages (from-to)107-116
Number of pages10
JournalVox Sanguinis
Volume114
Issue number2
Early online date18 Dec 2018
DOIs
Publication statusPublished - Feb 2019

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Syphilis
Blood Donors
Tissue Donors
Congenital Syphilis
Cost-Benefit Analysis
Blood Safety
Costs and Cost Analysis
Quality-Adjusted Life Years
Penicillins
Epidemiology
Economics
Infection

Cite this

Jayawardena, Thisuri ; Hoad, Veronica ; Styles, Claire ; Seed, Clive ; Bentley, Peter ; Clifford, Vanessa ; Lacey, Sarina ; Gastrell, Tessa. / Modelling the risk of transfusion-transmitted syphilis : a reconsideration of blood donation testing strategies. In: Vox Sanguinis. 2019 ; Vol. 114, No. 2. pp. 107-116.
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abstract = "Background and Objectives: Donor syphilis testing began in the 1940s amidst widespread transfusion-transmitted syphilis (TTS). Since then, the introduction of penicillin, pre-donation screening questionnaires and improved storage conditions have contributed to reducing transmission risk. Consequently, universal testing may no longer be cost-effective. This study analysed alternative options for donor syphilis testing to determine the optimal strategy. Materials and Methods: A model was developed using conservative parameter estimates for factors affecting TTS and 2009-2015 Australian donations to calculate risk outcomes (TTS infections, tertiary syphilis in recipients and transfusion-associated congenital syphilis) and cost-effectiveness of alternative testing strategies. The strategies modelled were as follows: universal testing, targeted-testing of high-risk groups (males ≤50 years old and first-time donors) and no testing. Results: The estimated risk of TTS is one in 49·5 million transfusions for universal testing, one in 6 million for targeted-testing of males ≤50 years old, one in 4 million for targeted-testing of first-time donors and one in 2·8 million for no testing. For all strategies, the risk of tertiary and congenital syphilis is <1 in 100 million. Universal testing is the least cost-effective strategy with an incremental cost-effectiveness ratio (ICER) estimated at $538·5 million per disability-adjusted life year averted. Conclusion: Universal testing is not required to maintain the risk of TTS within tolerable limits and is estimated to greatly exceed acceptable ICERs for blood safety interventions. However, despite a strong economic and risk-based rationale, given the epidemiology of syphilis in Australia is changing, feedback from critical stakeholders is not currently supportive of reducing testing.",
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Jayawardena, T, Hoad, V, Styles, C, Seed, C, Bentley, P, Clifford, V, Lacey, S & Gastrell, T 2019, 'Modelling the risk of transfusion-transmitted syphilis: a reconsideration of blood donation testing strategies' Vox Sanguinis, vol. 114, no. 2, pp. 107-116. https://doi.org/10.1111/vox.12741

Modelling the risk of transfusion-transmitted syphilis : a reconsideration of blood donation testing strategies. / Jayawardena, Thisuri; Hoad, Veronica; Styles, Claire; Seed, Clive; Bentley, Peter; Clifford, Vanessa; Lacey, Sarina; Gastrell, Tessa.

In: Vox Sanguinis, Vol. 114, No. 2, 02.2019, p. 107-116.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Modelling the risk of transfusion-transmitted syphilis

T2 - a reconsideration of blood donation testing strategies

AU - Jayawardena, Thisuri

AU - Hoad, Veronica

AU - Styles, Claire

AU - Seed, Clive

AU - Bentley, Peter

AU - Clifford, Vanessa

AU - Lacey, Sarina

AU - Gastrell, Tessa

PY - 2019/2

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N2 - Background and Objectives: Donor syphilis testing began in the 1940s amidst widespread transfusion-transmitted syphilis (TTS). Since then, the introduction of penicillin, pre-donation screening questionnaires and improved storage conditions have contributed to reducing transmission risk. Consequently, universal testing may no longer be cost-effective. This study analysed alternative options for donor syphilis testing to determine the optimal strategy. Materials and Methods: A model was developed using conservative parameter estimates for factors affecting TTS and 2009-2015 Australian donations to calculate risk outcomes (TTS infections, tertiary syphilis in recipients and transfusion-associated congenital syphilis) and cost-effectiveness of alternative testing strategies. The strategies modelled were as follows: universal testing, targeted-testing of high-risk groups (males ≤50 years old and first-time donors) and no testing. Results: The estimated risk of TTS is one in 49·5 million transfusions for universal testing, one in 6 million for targeted-testing of males ≤50 years old, one in 4 million for targeted-testing of first-time donors and one in 2·8 million for no testing. For all strategies, the risk of tertiary and congenital syphilis is <1 in 100 million. Universal testing is the least cost-effective strategy with an incremental cost-effectiveness ratio (ICER) estimated at $538·5 million per disability-adjusted life year averted. Conclusion: Universal testing is not required to maintain the risk of TTS within tolerable limits and is estimated to greatly exceed acceptable ICERs for blood safety interventions. However, despite a strong economic and risk-based rationale, given the epidemiology of syphilis in Australia is changing, feedback from critical stakeholders is not currently supportive of reducing testing.

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KW - blood safety

KW - residual risk estimation

KW - syphilis

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