Independent review
Completed
SaBTO hepatitis E virus (HEV) screening review and recommendations
Review of UK blood donor screening for hepatitis E virus (HEV), assessing current methods, risks and options to reduce transfusion-related HEV transmission.
Government Response
No formal government response published. The document is technical advice from SaBTO (the DHSC advisory committee on the safety of blood, tissues and organs), published by DHSC on 8 December 2025. Its recommendations are directed at SaBTO, blood services and clinicians rather than at ministers, and DHSC did not issue a ministerial response.
Recommendations
Recommendation 1
The increased cost of testing individual donations for HEV (£11 million per year) was over 60 times greater than its calculated health economic benefit (£176,000) based on a QALY value of £30,000. This economic calculation shows that testing individual donations for HEV RNA is not conventionally cost-effective, and if decisions to implement changes in testing are based purely on this health economic metric, the working group does not recommend any change to current screening practice.
Recommendation 2
The working group recognises the existence of less easily quantified factors such as reputational damage to the blood services if further incidents of HEV transmission occur with continuation of the less sensitive testing in ‘minipools’. Consequently, we advise that SaBTO evaluates risk tolerability as it applies to HEV screening and the extent to which conventional cost effectiveness calculations can be applied in the area of transfusion safety.
Recommendation 3
SaBTO should develop a communications plan for the report, for example by writing to relevant royal colleges to raise awareness of HEV infection in the management of patients. Early diagnosis and initiation of appropriate treatment may substantially reduce HEV -associated morbidity and mortality. Some members of the HEV Working Group co-authored a review in 2023 on maintaining the microbiological safety of the UK blood supply (see reference 3) that may contribute to greater awareness of transfusion-transmitted infections.
Recommendation 4
Each year, SaBTO should review the reported incidence of HEV infections in the wider community using epidemiological data provided by the UK Health Security Agency (UKHSA), and NAT positivity rates in UK blood and platelet donors. Changes in HEV incidence can be evaluated against the economic model developed in this report and the QALY costs can be reviewed. Large increases in HEV incidence should prompt a re-evaluation of HEV testing strategies by the UK blood services - NHS Blood and Transplant (NHSBT), the Scottish National Blood Transfusion Service (SNBTS), the Welsh Blood Service (WBS) and the Northern Irish Blood Transfusion Service (NIBTS).
Recommendation 5
Evaluation of current testing should be mindful of donation testing strategies by blood services in other countries and their HEV transmission risk evaluations.
Recommendation 6
A review of the effect of potential changes in the parameters used in the current report should be undertaken in 5 years. Those changes might include:
No recommendations with this response.