Health economics of blood transfusion in Zimbabwe

Health economic analyses quantify the costs and benefits of specific public health choices or interventions compared to current practice, thus informing decisions on the responsible use of scarce health care resources. The application of health economic evaluations to inform blood safety decisions has been growing over the past 10 years, particularly in high income countries. However, in sub-Saharan Africa where there is a greater need for improvements in blood safety amid severe resource constraints, health economic evaluations are still limited. This thesis presents the health economics of blood transfusion in a resource-limited setting, with the aim of helping decision-makers understand the cost-effectiveness of introducing a blood safety measure, individual donation – nucleic acid testing (ID-NAT). In particular, it discusses the chronic challenges in the collection, availability, accessibility and quality of empirical data; and their impact in informing health economic models. The thesis begins by describing the characteristics of patients receiving, and the adverse events following blood transfusions. The health related quality of life and healthcare costs for patients infected with HIV are also described. The screening costs for the serology tests currently implemented in Zimbabwe were estimated. All the data generated was collated and applied into a health economics model assessing the cost-effectiveness of introducing individual donation nucleic acid testing in addition to serologic testing in Zimbabwe. Despite further reducing the risk of viral transmission through blood transfusion, the introduction of nucleic acid testing in addition to the current serological screening, given the variables and underlying assumptions used, cannot be considered cost-effective for Zimbabwe. However, compared to high-income countries the cost-effectiveness is rather good.