A cost-effectiveness analysis of universal hepatitis C screening in all United States pregnancies

Challenges in Interpreting the Ob/Gyn Literature: Studies of Screening

“…Let us consider 2 studies that both evaluate the costeffectiveness of this approach. 21,22 First, although screening for HCV meets criteria as an effective screening test for the general adult population, we need to ask ourselves whether screening for HCV in pregnancy specifically also meets the criteria of an effective screening test. In this case, although there is not an accepted treatment for HCV in pregnancy, women are eligible for treatment postdelivery, and care established for pregnancy allows linkage to HCV care postpartum, and screening in pregnancy allows for appropriate neonatal evaluation and management of vertically transmitted HCV.…”

“…There are several differences in the analytic approaches of both studies. In one study, 22 universal screening is compared with riskbased screening, whereas in the other study, 21 universal screening is compared with no screening. These are important distinctions when interpreting the ICER in the context of how a potentially cost-effective intervention applies to the practice setting of the reader.…”

“…22 In contrast, in the study comparing universal to no screening, costs were decreased ($445 million cost-savings), and health states were significantly increased-in this case, no ICER is calculated, as the suggested strategy of universal screening is clearly the better choice over no screening, known as the dominant strategy. 21 However, when the cost of an HCV screening test increases to $114, universal screening is no longer cost-saving but remains cost-effective over a wide range of higher HCV screening test costs. 21 Let us turn to another example of costeffectiveness analysis in obstetrics.…”

“…21 However, when the cost of an HCV screening test increases to $114, universal screening is no longer cost-saving but remains cost-effective over a wide range of higher HCV screening test costs. 21 Let us turn to another example of costeffectiveness analysis in obstetrics. Here, we consider the screening strategy of transvaginal cervical length (CL) screening to prevent prematurity.…”

“…While hepatitis C screening with the HCV antibody test, with confirmatory testing with HCV RNA, accurately discriminates individuals with HCV, the value of implementing screening in all pregnancies requires cost-effectiveness analyses. Let us consider 2 studies that both evaluate the cost-effectiveness of this approach 21,22. First, although screening for HCV meets criteria as an effective screening test for the general adult population, we need to ask ourselves whether screening for HCV in pregnancy specifically also meets the criteria of an effective screening test.…”