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  • 1
    ISSN: 1365-2516
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Medicinal products of biological origin still carry a specific iatrogenic risk, mainly because of their starting material, mode of preparation and variability. Careful postmarketing surveillance systems are therefore necessary. To assess the long-term safety of haemophilia treatment with plasma-derived and recombinant clotting factor products, a cohort study was set up in France in 1994. Participants were patients with haemophilia A and B, with or without previous clotting factor therapy. Clinical events, treatments, biological data and adverse events were recorded on standard forms. Blood samples were separated into serum, plasma and peripheral blood mononuclear cells, frozen, and banked in a central laboratory. The same data and samples were collected at yearly follow-up visits. As of December 1999, 1234 haemophiliacs were enrolled in 39 haemophilia centres. At enrolment, 50.2% of patients were under 15 years of age, and the cumulative number of days of exposure to the product was below 50 in 35.1% of cases. The median duration of follow-up was 26.9 months, with a total of 2729 patient-years (135 947 days of exposure and 211 million units of factor VIII or IX). To date, only 17 patients were lost to follow-up. The initial results show good compliance with this health-watch policy among patients and clinicians specializing in haemophilia. The regular follow-up data and centralized sample bank will serve to investigate rapidly any suspected outbreaks as soon as reliable biological tests become available in the future.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The current approach to screening for hepatitis C and non-A, non-B, non-C hepatitis in French blood transfusion centers involves a combination of a transaminase assay and tests for antibodies to hepatitis B core antigen (anti-HBc) and antibodies to hepatitis C virus (anti-HCV). A decision-analysis model was used to assess the cost-effectiveness ratio of this approach compared to the former approach, which included only transaminase and anti-HBc screening. Cost data were collected by a questionnaire sent to 26 centers throughout France. The average costs of diagnostic kits, equipment, staff, and administration were calculated. Estimates of prevalence and sensitivity values came from the medical literature. The cost-effectiveness ratio was expressed in French francs per infected donor detected. A sensitivity analysis of the variables in the model was performed to estimate the validity of the cost-effectiveness ratio. For 100,000 donations the incremental cost of the current approach reached FrF 2,566,111 (about US $ 500,000), with a marginal effectiveness of 180 donations detected. The sensitivity analysis showed the effect of prevalence on the incremental cost-effectiveness ratio. Transfusion centers may change their screening approach in areas of high or low prevalence of hepatitis C in France.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The transfusion-related risk of transmission of hepatitis C virus (HCV) was evaluated in France for the periods before and after exclusion of donor blood units with the surrogate markers elevated alanine aminotransferase (ALT) levels and antibody to hepatitis B core antigen (anti-HBc). A total of 1,412 blood recipients undergoing surgery were followed up prospectively in the period from 1986 to 1989. The stored serum samples were tested for antibodies to HCV by an enzyme immunoassay (EIA) and the result in reactive sera confirmed by a recombinant immunoblot assay (RIBA). The risk of HCV transmission was estimated by the maximum likelihood method for a subpopulation of 892 recipients divided into three groups. Of 55 (3.9 %) EIA positive patients, 56.4 % were found to be positive prior to transfusion. HCV seroconversion (positive RIBA) occurred in 22 patients (1.6 %). The risk of HCV transmission per 1,000 transfused blood units decreased significantly from 4.11 in Group 1 (receiving non-screened blood) to 3.43 in Group II (receiving ALT screened blood) and to 1.40 in Group III (receiving ALT and anti-HBc screened blood). These results demonstrate that screening of donors for surrogate markers had reduced the risk of HCV transmission before the introduction of a systematic anti-HCV screening policy in France in March 1990.
    Type of Medium: Electronic Resource
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