Cost-effectiveness of transfusing virus-inactivated plasma instead of standard plasma

Virus inactivation of plasma intended for transfusion avoids the transmission of hepatitis B virus, hepatitis C virus, and HIV. However, because most plasma recipients also receive other blood components concomitantly, the procedure reduces but cannot eliminate the risk of transfusion-transmitted infection. As virus-inactivated plasma has just been licensed in the United States and other countries, a cost-effectiveness analysis is pertinent.

A Monte Carlo simulation of a Markov model representing the possible outcomes of plasma recipients was used to derive costs and utilities of transfusing virus-inactivated plasma instead of standard plasma. Probability distributions for patients' age and sex and for the number of blood components transfused per case were determined in 924 plasma recipients in a tertiary-care hospital. Other values were obtained from the medical literature. Results of the baseline and sensitivity analyses are the mean (+/- SD) of 10 simulations with 10(7) patients per simulation.

In the baseline analysis, transfusing virus-inactivated plasma instead of standard plasma prolonged the quality-adjusted survival by 1 hour and 11 minutes per patient, at a cost-effectiveness ratio of $2,156,398 +/- $257,587 per quality-adjusted life year gained. Cost-effectiveness was most sensitive to the patients' mean age, the incremental cost per unit of virus-inactivated plasma, the HIV and hepatitis C virus transmission rates, and the short-term mortality of plasma recipients due to their underlying diseases.

Compared to most accepted medical procedures, the transfusion of virus-inactivated plasma produces little health benefit at a very high cost. This poor cost-effectiveness ratio is due to the low current risk of infection with transfusion-transmitted viruses and to the greater age and poor short-term prognosis of most plasma recipients.