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Optimal portfolios of blood safety interventions: test, defer or modify?

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Abstract

A safe supply of blood for transfusion is a critical component of the healthcare system in all countries. Most health systems manage the risk of transfusion-transmissible infections (TTIs) through a portfolio of blood safety interventions. These portfolios must be updated periodically to reflect shifting epidemiological conditions, emerging infectious diseases, and new technologies. However, the number of available blood safety portfolios grows exponentially with the number of available interventions, making it impossible for policymakers to evaluate all feasible portfolios without the assistance of a computer model. We develop a novel optimization model for evaluating blood safety portfolios that enables systematic comparison of all feasible portfolios of deferral, testing, and modification interventions to identify the portfolio that is preferred from a cost-utility perspective. We present structural properties that reduce the state space and required computation time in certain cases, and we develop a linear approximation of the model. We apply the model to retrospectively evaluate U.S. blood safety policies for Zika and West Nile virus for the years 2017, 2018, and 2019, defining donor groups based on season and geography. We leverage structural properties to efficiently find an optimal solution. We find that the optimal portfolio varies geographically, seasonally, and over time. Additionally, we show that for this problem the approximated model yields the same optimal solution as the exact model. Our method enables systematic identification of the optimal blood safety portfolio in any setting and any time period, thereby supporting decision makers in efforts to ensure the safety of the blood supply.

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Data availability

The authors will publish a repository containing all data and code prior to publication.

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Acknowledgements

The authors thank Dr. Aman Verma for his helpful contributions in brainstorming and programming assistance.

Funding

Alton Russell was supported by a dissertation grant from Vitalant Research Institute as well by the Hsieh Family Fellowship, a Stanford Interdisciplinary Graduate Fellowship.

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Authors and Affiliations

  1. Department of Management Science and Engineering, Stanford University, Stanford, CA, USA

    W. Alton Russell & Margaret L. Brandeau

  2. Vitalant Research Institute, San Francisco, CA, USA

    W. Alton Russell & Brian Custer

  3. The University of California, San Francisco, San Francisco, CA, USA

    Brian Custer

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  1. W. Alton Russell
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Contributions

WAR conceptualized and performed the analysis and drafted the manuscript. BC contributed to the analysis design, provided data, and critically revised the manuscript. MB contributed to the analysis design and critically revised the manuscript. The author(s) read and approved the final manuscript.

Corresponding author

Correspondence to W. Alton Russell.

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Ethics approval

This analysis was based entirely on public data and was exempt from institutional ethics review.

Conflict of interest

Mr. Russell reports personal fees from Terumo BCT outside the submitted work. Dr. Custer reports grants from Grifols Diagnostic Solutions, Terumo BCT, Macopharma, and Cerus and personal fees from Terumo BCT outside the submitted work. Margaret Brandeau has no conflicts to declare.

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Russell, W.A., Custer, B. & Brandeau, M.L. Optimal portfolios of blood safety interventions: test, defer or modify?. Health Care Manag Sci 24, 551–568 (2021). https://doi.org/10.1007/s10729-021-09557-1

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  • DOI: https://doi.org/10.1007/s10729-021-09557-1

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