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An evaluation of the process and costs associated with targeted lookbacks for HCV and general notification of
J L Callum1, P H Pinkerton, A S Coovadia
1Department of Clinical Pathology, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada. jeannie.callum@swch5c.on.ca
Insights
Canadian hospitals notified over 28,000 blood transfusion recipients about HIV and Hepatitis C virus (HCV) risks. Targeted HCV lookbacks identified 47% of infected living patients, highlighting the importance of comprehensive blood safety measures.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Health Policy
Background:
- Canadian blood system inquiry recommended patient notification for HIV and HCV risks from transfusions between 1978 and May 1990.
- General notifications commenced in 1994 for HIV/HCV, with post-discharge notifications for transfusions after May 1990 starting in 1997.
- Targeted Hepatitis C virus (HCV) lookback programs were conducted from 1995 to 1999.
Purpose of the Study:
- To evaluate the effectiveness and cost of notifying transfusion recipients about potential HIV and HCV infections.
- To assess the outcomes of targeted HCV lookback initiatives.
- To determine the resources required for implementing national blood safety recommendations.
Main Methods:
- General notification process for 21,016 transfusion recipients (1978-1990), with 64% presumed contacted via registered mail.
- Ongoing notification system for transfusions post-May 1990, with contact rates not precisely determined.
- Targeted HCV lookback involving 256 recipients of specific blood components, with 94% contacted or deceased.
Main Results:
- CAN$373,481 was spent on general notifications, with significant costs attributed to digitizing paper records.
- In targeted HCV lookbacks, 56% of 84 living recipients tested positive for HCV.
- Restricting HCV lookbacks to post-1987 transfusions would have missed 39 living HCV-positive patients.
Conclusions:
- Total compliance cost reached CAN$569,636, notifying over 28,000 transfusion recipients.
- Successful implementation required accessible transfusion records, electronic data conversion, and administrative support.
- Targeted HCV lookbacks proved crucial for identifying infected individuals, despite higher per-patient costs.
Background:
The Commission of Inquiry on the Blood System in Canada recommended that hospitals notify patients who received blood between 1978 and May 1990 of the risks of contracting HIV (up to the end of 1985 only) and HCV infection. The commission also recommended that patients should be informed of any transfusion received.
Study Design And Method:
General notifications for HIV and HCV for this period were begun in mid-1994. Notification after discharge of transfusions received after May 1990 was begun in 1997. Targeted HCV lookback was performed from 1995 to 1999.
Results:
Of 21,016 transfusion recipients from January 1978 to May 1990 identified in the general look-back process and believed still alive, 13,549 (64%) were presumed contacted, by registered mail. The overall contact rate for the ongoing notifications (transfusions after May 1990) cannot be accurately determined, as registered mail was not used and a reply not requested. The total cost for these two processes was CAN$373,481, or $13 per patient believed contacted. Most (56%) of this cost was for the conversion to electronic form of paper transfusion records for the period 1978 through early 1984. In the targeted HCV lookback program 1995 through 1999, 94 percent of 256 recipients of specific components identified as likely to have transmitted HCV either were contacted or had died. Of 84 living recipients, 47 (56%) are HCV positive. The last documented potential seroconversion occurred after a transfusion in November 1991, during the period of first-generation EIA testing. If the targeted HCV lookback had been restricted to transfusions after 1987, as the FDA recommended, we would have failed to identify 39 living patients, of whom 21 are HCV positive. The cost per HCV-positive patient notified in the targeted HCV lookback was CAN $4,174.
Conclusion:
The cost of compliance with the com-mission's recommendations was CAN$569,636. Over 28,000 of 36,773 transfusion recipients were notified or presumed notified, and 272 targeted HCV lookbacks to 256 recipients were performed. Performance of this task required the existence of transfusion records back to 1978, conversion of paper records to electronic form, and adequate secretarial and financial support.
