The cost-effectiveness of screening blood donors for malaria by PCR

The cost-effectiveness of four blood donor screening strategies for malaria was estimated to determine whether transmission by transfusion can be reduced.

A decision analysis model was developed to compare 1) not screening allogeneic blood donors for malaria (Strategy 1); 2) using the standard questionnaire (Strategy 2); 3) using the standard questionnaire followed by testing blood donors with risk factors for malaria with PCR (Strategy 3); and 4) screening all blood donors using PCR (Strategy 4). The expected costs and the number of cases of malaria for each strategy were compared and incremental cost-effectiveness ratios were calculated as the cost per case of malaria averted. All costs are in Canadian dollars.

Strategies 2 and 3 had the same effectiveness but different costs, with Strategy 3 being less costly. Compared to Strategy 1, the incremental cost effectiveness ratio was 6463 dollars per case of malaria averted for Strategy 3. Strategy 4 resulted in less transmission of malaria (0.4/million donors), but the cost compared to Strategy 3 was 3,972,624 dollars per case of malaria averted.

The addition of PCR to the standard screening questionnaire is economically attractive compared to the current standard screening questionnaire.