Budget impact of implementing universal Plasmodium NAT screening in the blood transfusion system in the US

Blood donor deferral for malaria risk relies exclusively on responses to self-reported questionnaires. This study evaluated the economic impact of introducing Plasmodium nucleic acid testing (NAT) as a universal screening strategy in the United States.

A budget impact analysis comparing scenarios with and without universal Plasmodium NAT screening was conducted. In the testing scenario, question (Q) 29 on malaria risk was removed from the donor questionnaire. NAT was performed on mini-pools of 16 donations, followed by individual testing of reactive pools. Clinical, epidemiological, and cost inputs were obtained through a targeted literature review. The analysis adopted the perspective of blood suppliers and included a 1-to-3-year projection with a one-way sensitivity analysis. Costs were adjusted to 2021 USD.

Universal Plasmodium NAT screening is estimated to yield a net cost saving of 13,628,616 USD for US blood suppliers in the first year. While implementing NAT would add 4,443,286 USD in expenses, these costs would be offset by additional donations from donors previously deferred due to malaria risk identified by Q29 (266,438 extra blood products, resulting in 15,037,737 USD additional revenue), and labor savings of 3,034,165 USD from removing Q29, which is time-consuming, labor-intensive, and error-prone. Assuming an annual average increase of 2.4% in donations, projected savings are 13,865,670 USD in year 2 and 14,108,893 USD in year 3.

Implementing universal Plasmodium NAT screening could enhance the availability and safety of blood products in the United States while reducing labor costs and losses from collections from deferred donors.