Screening Blood Donations for Hepatitis C in Central Africa: Analysis of a Risk- and Cost-based Decision Tree

Four screening strategies (no testing, HC Abbott, HC Pasteur, and a combined test) for the detection of hepatitis C virus (HCV) antibody in donated blood were considered in a formal decision tree. Decision criteria included residual risk of infection and overall monetary cost. Tree parameters were determined using data from the Central African Republic. The prevalences observed among blood donors for HIV infection, hepatitis B, syphilis, and hepatitis C varied between 6 % and 15%. The current residual risk of transfusion-transmitted infections is very high (8.4%). Screening for HCV would bring that risk down to about 3 % with either the HC Pasteur, the HC Abbott, or the combined test. Even though baseline analysis gives preference to the HC Abbott test (the com-bined test coming out last), Monte Carlo sensitivity and uncertainty analyses showed that Abbott’s and Pasteur’s tests are interchangeable, on the basis or either risk or cost considerations. Key words: Africa; blood donation; blood transfusion; decision tree analysis; hepatitis B virus; hepatitis C virus; human immunodeficiency virus; Monte Carlo; syphilis. (Med Decis Making 1999;19:296–306) In industrialized countries, prevention of transfu