Duffy testing to benefit children’s population health: a cost-effectiveness analysis∗
7 affiliations
- 1Division of Hematology/Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI
- 2Section of Medical Oncology and Hematology, Yale School of Medicine and Yale Cancer Center, New Haven, CT
- 3Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
- 4C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI
- 5Division of Hematology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- 6American Society of Hematology, Washington, DC
- 7Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
Abstract
The Duffy-null phenotype is reported in ∼1 in 10 individuals in the United States and results in absolute neutrophil counts (ANC) that are 40% to 50% lower than most institutional reference intervals. Misinterpretation of normal ANC values for this population leads to avoidable diagnostic testing and referrals. We aimed to evaluate the economic value of serologic Duffy testing vs no testing obtained alongside other recommended blood work at 9 to 12 months of age, using a Markov cohort design incorporating all levels of currently practiced diagnostic neutropenia workups across scenario analyses. The analysis was conducted from a US societal perspective over a lifetime horizon across all accepted willingness-to-pay thresholds. The primary outcome was the incremental net monetary benefit (iNMB) in US dollars ($) per quality-adjusted life-year. Duffy testing was favored in the base-case and all scenario analyses, with iNMB ranging from $2.18 to $92.77 per child tested for Duffy status. The cost of Duffy serological testing, the cost of the neutropenia workup, and the prevalence of low ANC were the 3 parameters with the greatest variation that affected the iNMB. Probabilistic analyses showed that universal testing was favored in 100%, 100%, 100%, 95%, and 100% of 10 000 iterations in the base-case, full workup, annual follow-up, minimal workup, and targeted testing scenarios, respectively. The Duffy-null prevalence threshold required for universal testing to be cost-effective was 7.6%, 1.6%, 1.3%, and 9.0%, respectively, and 4.9% for targeted testing. At these thresholds, universal serologic Duffy testing would align with cost-effective implementation in at least 20 states in the United States today.
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BibTeX
@article{merz2026duffy,
title = {{Duffy testing to benefit children’s population health: a cost-effectiveness analysis∗}},
author = {Lauren E. Merz and Satoko Ito and Manraj Sra and Ding Quan Ng and Kelly Walkovich and Maureen Okam Achebe and Patricia Frustace and Nathalie van Havre and George Goshua},
journal = {Blood Advances},
year = {2026},
month = jul,
doi = {10.1182/bloodadvances.2026019827},
url = {https://doi.org/10.1182/bloodadvances.2026019827},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Duffy testing to benefit children’s population health: a cost-effectiveness analysis∗
AU - Lauren E. Merz
AU - Satoko Ito
AU - Manraj Sra
AU - Ding Quan Ng
AU - Kelly Walkovich
AU - Maureen Okam Achebe
AU - Patricia Frustace
AU - Nathalie van Havre
AU - George Goshua
PY - 2026
DA - 2026/07/24
JO - Blood Advances
DO - 10.1182/bloodadvances.2026019827
UR - https://doi.org/10.1182/bloodadvances.2026019827
AB - The Duffy-null phenotype is reported in ∼1 in 10 individuals in the United States and results in absolute neutrophil counts (ANC) that are 40% to 50% lower than most institutional reference intervals. Misinterpretation of normal ANC values for this population leads to avoidable diagnostic testing and referrals. We aimed to evaluate the economic value of serologic Duffy testing vs no testing obtained alongside other recommended blood work at 9 to 12 months of age, using a Markov cohort design incorporating all levels of currently practiced diagnostic neutropenia workups across scenario analyses. The analysis was conducted from a US societal perspective over a lifetime horizon across all accepted willingness-to-pay thresholds. The primary outcome was the incremental net monetary benefit (iNMB) in US dollars ($) per quality-adjusted life-year. Duffy testing was favored in the base-case and all scenario analyses, with iNMB ranging from $2.18 to $92.77 per child tested for Duffy status. The cost of Duffy serological testing, the cost of the neutropenia workup, and the prevalence of low ANC were the 3 parameters with the greatest variation that affected the iNMB. Probabilistic analyses showed that universal testing was favored in 100%, 100%, 100%, 95%, and 100% of 10 000 iterations in the base-case, full workup, annual follow-up, minimal workup, and targeted testing scenarios, respectively. The Duffy-null prevalence threshold required for universal testing to be cost-effective was 7.6%, 1.6%, 1.3%, and 9.0%, respectively, and 4.9% for targeted testing. At these thresholds, universal serologic Duffy testing would align with cost-effective implementation in at least 20 states in the United States today.
SN - 2473-9529
SN - 2473-9537
ER -