Is antenatal screening for hepatitis C virus cost-effective? A decade’s experience at a London centre

Selvapatt, Nowlan; Ward, Thomas; Bailey, Heather; Bennett, Hayley; Thorne, Claire; See, Lay-May; Tudor‐Williams, Gareth; Thursz, Mark; McEwan, Phil; Brown, Ashley

doi:10.1016/j.jhep.2015.05.015

Cited by 46 publications

(39 citation statements)

References 29 publications

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“…To our knowledge, our study is the first to evaluate the cost-effectiveness of HCV screening among pregnant women in the U.S. Our findings conflict with a previous study which found HCV screening among pregnant women in the United States not cost-effective, (42) but that study utilized old interferon-based treatments with low cure rates. Our findings are consistent with a recent study founding antenatal screening in the UK cost-effective with newer interferon-based therapies (43). Our findings are also consistent with studies finding HCV screening in the DAA era cost-effective among a variety of U.S. populations such as adolescents and young adults in primary care settings (35), in prisons (44), in methadone programs (24), and one-time testing strategies in the general population.…”

Section: Discussionsupporting

confidence: 92%

Cost-effectiveness of Universal Hepatitis C Virus Screening of Pregnant Women in the United States

Chaillon

Rand

Reau

et al. 2019

Clinical Infectious Diseases

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/userguides/explore-bristol-research/ebr-terms/ ABSTRACT Background: Hepatitis C Virus (HCV) chronic prevalence among pregnant women in the United States (U.S.) U.S. doubled nationally from 2009-2014 (~0.7%), yet many remain undiagnosed. Screening pregnant women is not recommended by the Society of Maternal-Fetal Medicine or the Centers for Disease Control and Prevention, despite new AASLD/IDSA guidelines recommending screening this group. We assessed the cost-effectiveness of HCV screening for pregnant women in the U.S. Methods:An HCV natural history Markov model was used to evaluate the cost-effectiveness of universal HCV screening of pregnant women followed by treatment after pregnancy compared to background riskbased screening from a health care payer perspective. We assumed 0.73% HCV chronic prevalence among pregnant women based on national data. We assume no Medicaid reimbursement restrictions by fibrosis stage at baseline, but explore differing restrictions in sensitivity analyses. We assessed cost (in USD$) and health outcomes (in quality-adjusted life years, QALYs) over a lifetime horizon, using new HCV drug costs of $25,000/treatment. We assess mean incremental cost-effectiveness ratios (ICERs) under a willingness to pay threshold of $50,000/QALY gained. We additionally evaluate potential population impact.Results: Universal antenatal screening was cost-effective in all treatment eligibility scenarios (mean ICER <$3,000/QALY gained). Screening remained cost-effective at 0.07% prevalence, the lowest estimated prevalence state in the U.S. (Hawaii). Screening the ~5.04 million pregnant women in 2018 could result in detection and treatment of 33,000 women based on current fibrosis restrictions. Conclusions:Universal screening for HCV among pregnant women in the U.S. is cost effective and should be recommended nationally.

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Section: Discussionsupporting

confidence: 92%

Cost-effectiveness of Universal Hepatitis C Virus Screening of Pregnant Women in the United States

Chaillon

Rand

Reau

et al. 2019

Clinical Infectious Diseases

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“…The MONARCH (MOdelling the NAtural histoRy and Cost effectiveness of Hepatitis C) model is a previously published and validated HCV disease progression and cost‐effectiveness model designed to progress a cohort of subjects in annual cycles through METAVIR fibrosis stages and potentially end‐stage liver disease (ESLD) complications and death . Patients in METAVIR fibrosis stages F0–F4 incur an annual probability of all‐cause mortality .…”

Section: Methodsmentioning

confidence: 99%

The cost impact of outreach testing and treatment for hepatitis C in an urban Drug Treatment Unit

Selvapatt

Ward

Harrison

et al. 2016

Liver International

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“…Seventeen studies assessed the costs and effects of screening programs and antiviral treatments: seven evaluated screening in general population or subgroup of general population, five in people who inject drugs, four in high‐risk populations and three in other populations . It is to be noted here that two studies evaluated the cost‐effectiveness of HCV screening in more than one population group (general and high‐risk population, and people who inject drugs and high‐risk population).…”

Section: Resultsmentioning

confidence: 99%

Systematic review: economic evaluations of HCV screening in the direct‐acting antivirals era

Cortesi

Barca

Giudicatti

et al. 2019

Aliment Pharmacol Ther

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Background:The World Health Organization estimated that 90% of the infected people need to be diagnosed and 80% need to be treated to reach the aim of hepatitis C virus (HCV) elimination by 2030. For this reason, all possible strategies to detect and treat HCV-infected people need to be carefully evaluated to implement the best one. Aim: To review and synthesise the economic evaluations of HCV screening programs conducted in the era of direct-acting antiviral agents regimens. Methods: A systematic literature review was conducted until April 2018 to provide information on the costs and effectiveness of HCV screenings in direct-acting antiviral agents era. A critical assessment of the quality of economic evaluations retrieved was conducted. Results: The literature search identified 716 references; 17 of them assessed cost and effectiveness of screening programs and antiviral treatments in different populations: general population (n = 7), drug users (n = 5), high-risk populations (n = 4) and other populations (n = 3). The HCV screening and direct-acting antiviral agents treatment appear to be good value for money, both in general and high-risk populations, if a cost per quality adjusted life years of $50 000 is set as willingness to pay threshold. Some studies showed the value of including lower stage of fibrosis in the treatment selection criteria.Conclusions: Several HCV screening strategies plus direct-acting antiviral agents treatments resulted cost-effectiveness in different populations. However, there is still need of country and population-specific evaluations within the different HCV screening and treatment strategies available, in order to assess their cost-effectiveness and sustainability and fully support an evidence-informed policy for HCV elimination.

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Is antenatal screening for hepatitis C virus cost-effective? A decade’s experience at a London centre

Abstract: Background: This study aims to assess the cost-effectiveness of a routine

Cited by 46 publications

References 29 publications

Cost-effectiveness of Universal Hepatitis C Virus Screening of Pregnant Women in the United States

Cost-effectiveness of Universal Hepatitis C Virus Screening of Pregnant Women in the United States

The cost impact of outreach testing and treatment for hepatitis C in an urban Drug Treatment Unit

Systematic review: economic evaluations of HCV screening in the direct‐acting antivirals era

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