Residual risks estimating models of transmission of HBV, HIV and HCV with different assays : lesson for screening strategies for Chinese blood banks

Abstract

Blood safety is an issue of public health concern. Sensitive screening assays for excluding infectious donations have been widely adopted to reduce the risk of transfusion-transmitted infections, especially for hepatitis B virus (HBV), hepatitis C virus (HCV) and (human immunodeficiency virus) HIV infections. Even with sensitive screening assays, residual risk of undetectable infectious donations remains because donations may be made in the “window period” when the infection is present but difficult to detect with serological tests. Currently, serological screening tests are mainly used in China, rather than the more expensive and sensitive DNA based tests. From a public health perspective, choice of the screening test depends on overall cost-effectiveness, including assessment of the residual risk. To facilitate a full cost-effectiveness analysis, this review identifies the best residual risk estimating model in a Chinese setting. The search was conducted using databases including PubMed and ISI Web of Knowledge filtered by publication date, English language and accessibility of full text. Both exclusion and inclusion criteria were used for articles identification. Five papers on residual model estimation were retrieved. The blood donor profile in China was used to understand how these models differ and how these differences would affect their use and interpretation. This study identified the Michael P. Busch model as the optimal residual risk estimating model for Chinese blood banks’ to facilitate the cost-effectiveness assessment of a screening strategy in terms of achieving a balance of blood safety and cost.