Brian S. Custer, Ph.D., M.P.H.

Current Position:

• Assistant Investigator, Epidemiology and
  Health Policy Research, BSRI

Contact Information:
270 Masonic Avenue
San Francisco, CA 94118
Phone: (415) 901-0756
Fax: (415) 901-0733
Email: bcuster@bloodsystems.org

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Download a curriculum vitae [pdf file]

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Education:

• B.S., Biology, University of Oregon
• M.P.H., Epidemiology, University of Washington
• Ph.D., Health Outcomes Research, University of Washington

Training/Appointments:

• Research Assistant, Department of Neurology, Harborview Medical Center, University of Washington
• Teaching Assistant, School of Public Health and Community Medicine and School of Pharmacy, University of Washington

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Research Interests:

• Epidemiological studies of safety initiatives in blood banking
• Consequences of temporary donor deferral
• Sufficiency of the U.S. blood supply
• Economic analysis of blood safety and transfusion medicine interventions
• Strategies for and yield of donated blood testing, such as West Nile virus (WNV) and other current or emerging threats to blood safety

Current research

Economic Analysis of Blood Safety and
Transfusion Medicine Interventions

The safety of the blood supply is held to a level of public, political and legal scrutiny that few areas of health care endure. The search for zero risk in donated blood creates an atmosphere in which no intervention seems too expensive. In a recently published systematic review of blood safety interventions, Dr. Custer highlighted the lack of economic evaluation of many adopted interventions. Because resources for blood supply safety are limited,  future interventions will require a more thorough look at cost and consequences.

Estimating Blood Donor Loss Due to Variant Creutzfeldt-Jakob Disease (vCJD) Travel Deferral

Until recently, the population of the United States has largely been spared from concerns about bovine spongiform encephalopathy (BSE) and specifically vCJD (the human form of BSE, also known as mad cow disease). Over the past year, two cases of BSE have been diagnosed in cattle born in Canada and imported to the United States. In the United Kingdom, two cases of transfusion-related transmission of vCJD have been detected, though no such cases have been detected in the United States.

The implementation of vCJD blood donor deferral policy is controversial and the actual number of blood donors eliminated from blood donation is unknown. Dr. Custer designed a study to estimate the deferral rate for Blood Centers of the Pacific that used the results of a questionnaire on the European travel history of blood donors in conjunction with a mathematical model of community blood supply production he developed.

Expanded vCJD travel deferral will lead to the indefinite deferral of nearly 3,400 donors at BCP in the first year following adoption of the deferral, reducing the supply of blood by almost 3,200 units out of an approximate 95,000-unit annual supply. Because of this, the cost of procuring each unit will increase by 50 cents from the blood bank perspective, and by $1.15 from the societal perspective.

WNV Studies

After the introduction of WNV in 1999, the United States experienced the largest arbovirus epidemic in recorded history in 2003. Documentation of WNV by transfusions and organ transplants in late 2002 led to a major regulatory and industry-driven effort to implement nucleic acid technology (NAT) testing of donations. During the 2003 epidemic season, WNV NAT testing resulted in the capture of approximately 1,000 viremic donations, potentially preventing more than 1,500 transfusion-transmitted infections. However, testing has not completely eliminated “breakthrough” infections, all of which were not detectible by testing procedures in place at the time. More sensitive tests to detect these blood units with low levels of viremia exist, but they are more expensive and labor intensive.

Dr. Custer determined when to use these sensitive tests for blood donation testing within an area experiencing a WNV epidemic in such a way to maximize safety, without wasting resources. Results of this analysis were used to help develop WNV testing policy for all of the blood banks in Blood Systems, Inc. and for other blood banks that use Blood Systems Laboratories for donation testing. In a separate study Dr. Custer assessed the cost effectiveness of screening for WNV in the U.S. This analysis brought together three important factors: (1) the testing procedures used, (2) seasonal aspects of WNV activity, and (3) the presence of geographically localized WNV activity (hot spots). The cost effectiveness of screening for WNV varies according to assumptions made regarding these factors and is influenced most greatly by the prevalence of WNV in blood donors.

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Publications

Custer BS, Tomasulo PA, Murphy EL, Caglioti S, Harpool D, McEvoy P, Busch MP. Triggers for switching from minipool testing by nucleic acid technology to individual-donation nucleic acid testing for West Nile virus: Analysis of 2003 data to inform 2004 decision making. Transfusion. Nov;44(11):1547-54 2004.

Custer BS, Johnson ES, Sullivan SD, Hazlet TK, Ramsey SD, Murphy EL, Busch MP. Quantifying losses to the donated blood supply due to donor deferral and miscollection. Transfusion. Oct;44(10):1417-26 2004.

Custer BS, Sullivan SD, Hazlet TK, Iloeje U, Veenstra DL, Kowdley V. Global epidemiology of hepatitis b virus. Journal of Clinical Gastroenterology. 38(10) Suppl 3;158-68 2004.

Custer BS. Economic analyses of blood safety and transfusion medicine interventions: a systematic review. Transfusion Medicine Reviews. April;18(2):127-143 2004.

Custer BS, Koepsell TD, Mueller BA. The association between breast carcinoma and meningioma in women. Cancer. Mar 15;94(6):1626-35 2002.

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