Leslie S. Valberg

Screening Blood Donors for Hereditary Hemochromatosis: Decision Analysis Model Based on a 30-Year Database

BACKGROUND & AIMS The high prevalence, morbidity, premature death, and benefit of early diagnosis and treatment make hemochromatosis a prime target for screening in the white population. Decision analysis techniques were used to compare the outcome, utility, and incremental cost savings of a plan to screen voluntary blood donors for hemochromatosis. METHODS The screening strategy includes sequential testing of serum unsaturated iron-binding capacity, serum transferrin saturation, serum ferritin, and either hepatic iron index or venesections to measure exchangeable body iron. Estimates of prevalence, asymptomatic intervals, probabilities of life-threatening clinical complications, symptom-specific life expectancy, and sensitivity and specificity of screening tests are based on our database of 170 hemochromatosis homozygotes and the published literature. RESULTS The screening strategy led to an incremental increase in utility of 0.84 quality-adjusted life days with an incremental cost savings of

Transferrin Receptors in the Human Gastrointestinal Tract Relationship to Body Iron Stores

3.19 per blood donor screened. When the potential of identifying asymptomatic homozygous siblings was included, these values increased to 1.18 quality-adjusted life days and

Screening blood donors for hereditary hemochromatosis: decision analysis model comparing genotyping to phenotyping.

12.57 per person screened. Screening remained a dominant strategy given a prevalence of hemochromatosis of > 0.0026 or an initial screening test cost of <

Diagnostic Efficacy of Hepatic Computed Tomography in the Detection of Body Iron Overload

8. CONCLUSIONS Screening blood donors for hemochromatosis has the potential to improve overall societal health status and decrease third-party payer health care costs over the long-term.

Gastrointestinal absorption and organ distribution of oral cadmium chloride and cadmium‐metallothionein in mice

Fluorescently labeled antibodies were used to identify transferrin receptors and mucosal transferrin in human gastrointestinal biopsy sections. Transferrin receptors were evident in the villous epithelium and the crypt areas of duodenum, ileum, and colon, predominantly in the basal-lateral area. In 7 subjects with low iron stores, the intensity of duodenal villous staining for receptor, on a scale of 0-4, was 2.1 +/- 0.3 (mean +/- SD). This value was significantly higher than the value in 13 subjects with normal iron stores (1.1 +/- 0.4). In 5 patients with hereditary hemochromatosis, duodenal transferrin receptor staining was not significantly different from that in the subjects with normal iron stores. Transferrin staining was found in the apical cytoplasm of epithelial cells in the duodenum, ileum, and colon, but observer assessment was not sufficiently reproducible to make a quantitative analysis. Our results suggest that iron deficiency is accompanied by an increase in transferrin receptors in duodenal absorptive cells, and the genetic lesion in hemochromatosis does not involve an increase in transferrin receptors in the intestinal mucosa compared with subjects with normal iron stores.

Measurement of dietary cadmium absorption in humans

ObjectiveThe identification of a gene for hereditary hemochromatosis in 69–100% of typical hemochromatosis patients has resulted in a genotypic test to identify persons with the typical missense mutation. Population screening by genotyping has the potential to reduce screening costs because of a high specificity of the genetic test.MethodsDecision analysis techniques are used to compare the outcome, utility, and incremental cost savings of a plan to screen voluntary blood donors and their siblings for hemochromatosis using a genotypic test (C282Y mutation) with phenotypic tests (transferrin saturation, serum ferritin).ResultsGenotypic screening is less expensive than phenotypic screening only if the cost of the initial genetic test is less than

Zinc absorption and leukocyte zinc in alcoholic and nonalcoholic cirrhosis

20. The screening program saves money (dominant strategy) if the cost of the initial genetic test is less than

Cadmium-induced enteropathy: comparative toxicity of cadmium chloride and cadmium-thionein.

28. Incremental cost saving declines as the cost of the gene test increases. At a gene test cost of

Zinc absorption in inflammatory bowel disease

173, it costs

Low Serum 25-Hydroxyvitamin in Hereditary Hemochromatosis:Relation to Iron Status

109,358 to identify a homozygote with potential life-threatening illness. Incremental cost saving also declines as the penetrance of the hemochromatosis gene in the population screened decreases. Phenotypic screening with confirmatory genetic testing results in a cost of