Screening blood donors for hereditary hemochromatosis: decision analysis model based on a 30-year database

Gastroenterology. 1995 Jul;109(1):177-88. doi: 10.1016/0016-5085(95)90283-x.

Abstract

Background & aims: The high prevalence, morbidity, premature death, and benefit of early diagnosis and treatment make hemochromatosis a prime target for screening in the white population. Decision analysis techniques were used to compare the outcome, utility, and incremental cost savings of a plan to screen voluntary blood donors for hemochromatosis.

Methods: The screening strategy includes sequential testing of serum unsaturated iron-binding capacity, serum transferrin saturation, serum ferritin, and either hepatic iron index or venesections to measure exchangeable body iron. Estimates of prevalence, asymptomatic intervals, probabilities of life-threatening clinical complications, symptom-specific life expectancy, and sensitivity and specificity of screening tests are based on our database of 170 hemochromatosis homozygotes and the published literature.

Results: The screening strategy led to an incremental increase in utility of 0.84 quality-adjusted life days with an incremental cost savings of $3.19 per blood donor screened. When the potential of identifying asymptomatic homozygous siblings was included, these values increased to 1.18 quality-adjusted life days and $12.57 per person screened. Screening remained a dominant strategy given a prevalence of hemochromatosis of > 0.0026 or an initial screening test cost of < $8.

Conclusions: Screening blood donors for hemochromatosis has the potential to improve overall societal health status and decrease third-party payer health care costs over the long-term.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Blood Donors*
  • Child
  • Costs and Cost Analysis
  • Decision Support Techniques*
  • Decision Trees
  • Female
  • Ferritins / blood
  • Hemochromatosis / epidemiology
  • Hemochromatosis / genetics
  • Hemochromatosis / prevention & control*
  • Homozygote
  • Humans
  • Information Systems*
  • Iron / blood
  • Iron / metabolism
  • Life Expectancy
  • Liver / metabolism
  • Male
  • Mass Screening* / economics
  • Middle Aged
  • Prevalence
  • Sensitivity and Specificity
  • Transferrin / analysis

Substances

  • Transferrin
  • Ferritins
  • Iron