CJD is a rare but fatal non-inflammatory neurodegenerative condition. Its origin in humans stems from the ingestion of beef from cattle infected with a related disease, bovine spongiform encephalitis. CJD can also be transmitted by blood transfusion, even if the donor is clinically asymptomatic.
The majority of CJD cases have occurred in the United Kingdom and Ireland.
Transfusion services currently use risk-reduction strategies, such as donor deferral and leukocyte reduction, to minimize the risk of transfusion-transmitted CJD. However, detection methods for asymptomatic donors are not available. Prion filtration, a method of reducing residual protein in donated blood, has been proposed as an additional strategy to improve blood safety.
Dr. Conor Teljeur, and colleagues from the Health Information and Quality Authority in Dublin, Irelan recently published an article in the journal Transfusion. In the article, they assessed the cost-effectiveness of implementing prion filtration as a strategy to reduce the risk of transfusion-transmitted CJD.
Dr. Teljeur’s model compared the expected incidence of clinical CJD when implementing a strategy of universal prion filtration compared to the absence of filtration.
Their study found that over a ten-year period with universal prion filtration, two transfusion transmitted CJD infections would be prevented and 18.5 life-years would be saved. With a total cost of 68.2 million euros over ten years, universal filtration would cost 3.7 million euros per life-year gained. Therefore, the authors concluded that universal prion filtration would not be cost-effective.
An accompanying editorial was written by Dr. William Murphy of University College, Dublin. In it, he asserts that although cost-effectiveness and cost-utility analyses are commonly used, they may not be consistent with public perceptions on the value of blood safety.
Dr. Murphy goes on to note: “National Blood Transfusion Program and the Health Services Executive in Ireland and University College, Dublin”
“It’s important to implement safety measures early and perhaps pull back those measures later as they are found to be redundant. So ideally, you would put in place robust measures in advance, some of these might include reducing patient’s exposure to blood transfusion, or for some instances, not letting people who have been previously transfused subsequently donate blood, or at least not until a test for the new disease has been developed.”
In conclusion, Dr. Murphy suggests that adoption of prion filtration at the early stages of an epidemic might reduce CJD transmission, but it would be several years until the impact of this strategy could accurately be assessed. However, he also cautions that blood-borne pathogens are unpredictable and can pose serious threats to blood safety.
We’ll be back on November 30th with another edition of Transfusion News. In the meantime, you can always keep up to date with all of the latest news by visiting transfusionnews.com. Thanks for joining us.
References
1. Teljeur C, Flattery M, Harrington P, O’Neill M, Moran PS, Murphy L, Ryan M: Cost-effectiveness of prion filtration of red blood cells to reduce the risk of transfusion-transmitted variant creutzfeldt-jakob disease in the republic of ireland. Transfusion 2012;52:2285-2293.
2. Murphy WG: Of mad cows and bolted horses: The economics of blood safety. Transfusion 2012;52:2278-2281.
