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<p>Nucleic acid testing (NAT) enhances blood safety by reducing transfusion-transmitted infections (TTIs), viz. HBV, HCV, and HIV. This study assesses cost-effectiveness of ‘NAT + serology’ compared to ‘serology alone’ for blood screening in India. Using a decision-analysis model, the cost, health outcomes and cost effectiveness of using ‘serology alone’ or ‘NAT + serology’ were compared from a limited public-sector societal perspective. The transmission risk for each TTI for both screening strategies was estimated using the window period approach. Costs and utilities were collected form published literature for different health states for the three TTIs. Disease management costs and disability-adjusted life-years (DALYs) averted were calculated over the lifetime of the annual infected cohort. Cost-effectiveness was established if the incremental cost-effectiveness ratio (ICER) was below than the national GDP per capita (2022-23). The same model was adopted for individual States and Union Territories (UTs) in India. NAT + serology was estimated to prevent 61,598 cases of TTIs, averting 37,268 TTI-related deaths in one year across India, translating to 4,15,734 DALYs averted. While NAT incurs INR 1,506.58 crore additional incremental cost, it saves INR 2,522.68 crore by reducing disease management costs, and INR 8,189.26 crore by averting DALYs. The net annual cost savings due to NAT is expected to be INR 9,205.35 crore. NAT + serology is also expected to be cost-effective with ICER values for all three TTIs combined (-INR 24,441), HBV (-INR 65,287), HCV (-INR 24,343), and HIV (INR 69,392) being below the national GDP per capita of INR 1,96,983. NAT + serology was also cost-effective in all the states and UTs of India for which data were available, and was in fact cost-saving in several states/ UTs. NAT remained cost-effective across a range of NAT costs from INR 800 to INR 1500. Implementing NAT in addition to serology will be cost-effective, and yield substantial cost savings. The reduction in costs, TTIs, deaths and DALYs averted advocates for policy change mandating NAT in blood banks.</p>

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Health Economic Benefits of Implementing Nucleic Acid Testing in Addition To Serology for Blood Transfusion Safety in India: a Cost-Effectiveness Analysis

  • 期刊论文

  • 发表日期：

    2025年12月2日

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  • Deepika Kourchand Jindal,
  • Mandakini Das Sarmah,
  • Sandeep Sewlikar,
  • Kaizad Wadia

摘要

Nucleic acid testing (NAT) enhances blood safety by reducing transfusion-transmitted infections (TTIs), viz. HBV, HCV, and HIV. This study assesses cost-effectiveness of ‘NAT + serology’ compared to ‘serology alone’ for blood screening in India. Using a decision-analysis model, the cost, health outcomes and cost effectiveness of using ‘serology alone’ or ‘NAT + serology’ were compared from a limited public-sector societal perspective. The transmission risk for each TTI for both screening strategies was estimated using the window period approach. Costs and utilities were collected form published literature for different health states for the three TTIs. Disease management costs and disability-adjusted life-years (DALYs) averted were calculated over the lifetime of the annual infected cohort. Cost-effectiveness was established if the incremental cost-effectiveness ratio (ICER) was below than the national GDP per capita (2022-23). The same model was adopted for individual States and Union Territories (UTs) in India. NAT + serology was estimated to prevent 61,598 cases of TTIs, averting 37,268 TTI-related deaths in one year across India, translating to 4,15,734 DALYs averted. While NAT incurs INR 1,506.58 crore additional incremental cost, it saves INR 2,522.68 crore by reducing disease management costs, and INR 8,189.26 crore by averting DALYs. The net annual cost savings due to NAT is expected to be INR 9,205.35 crore. NAT + serology is also expected to be cost-effective with ICER values for all three TTIs combined (-INR 24,441), HBV (-INR 65,287), HCV (-INR 24,343), and HIV (INR 69,392) being below the national GDP per capita of INR 1,96,983. NAT + serology was also cost-effective in all the states and UTs of India for which data were available, and was in fact cost-saving in several states/ UTs. NAT remained cost-effective across a range of NAT costs from INR 800 to INR 1500. Implementing NAT in addition to serology will be cost-effective, and yield substantial cost savings. The reduction in costs, TTIs, deaths and DALYs averted advocates for policy change mandating NAT in blood banks.