Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. This microsimulation study suggested that screening blood for Zika virus is only cost-effective during the high mosquito season in Puerto Rico.

2. The authors of the study did not identify any cost-effective screening policy for Zika virus in the 50 states.

Evidence Rating Level: 2 (Good)

### Study Rundown:

Zika is an emerging infectious disease that increased in prevalence in the Americas in 2015 with the largest recorded outbreak to date. Considering the significant comorbidities associated with Zika virus infection, including microcephaly in newborns and Guillain-Barre syndrome, it is becoming increasingly important to implement measures of protecting blood transfusion recipients from exposure to Zika virus. In 2016, universal individual donation nucleic acid testing was conducted for donated blood for Zika virus in the United States. The authors of this study evaluated the cost-effectiveness of this universal screening during the first year of the process, compared to alternatives for the 50 states and separately for Puerto Rico. The authors did not find that screening all donated blood for Zika virus in all 50 states was cost-effective. It was only cost effective in Puerto Rico during the season of high mosquito activity. The main study limitation was that long-term sequelae of infection were not evaluated in this study. However, this study does provide insights that should help inform policy decisions and future research.

### In-Depth [cost-effectiveness analysis]:

The authors conducted a microsimulation study to evaluate the cost-effectiveness of screening all donated blood for Zika virus in the United States. The model utilized the blood center costs, adverse events and lifetime health economic consequences of adverse events due to transfusion of the Zika virus. The authors did not find any cost-effective screening policies in the 50 states during their analysis. Specifically, no intervention was cost-effective in 99.99% of simulation iterations. In contrast, in Puerto Rico, the authors observed that screening during the high mosquito activity season was the most cost-effective in 64% of probabilistic sensitivity analysis iterations. In the case analyses, this was cost effective at $81,123 per QALY (95% CI, -$49,138 to \$978,242 per QALY) with mini-pool NAT in high season and no testing in low season. The authors observed that with no transfusion intervention in Puerto Rico, an estimated 242.2 cases (95% CI, 194.9 to 291.5 cases) of transfusion transmission would have occurred during one year. This value contrasted with the 50 states and Washington, DC, where an estimated 44.7 cases (CI, 32.1 to 59.1 cases) of transfusion transmission would have occurred in one year with no intervention.

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