Routine screening for hepatitis C in pregnancy is cost‐effective in a large urban population in Ireland: a retrospective study

Abstract

Objective To investigate whether risk factor-based screening in pregnancy is failing to identify women with hepatitis C virus (HCV) infection and to assess the cost-effectiveness of universal screening.Design Retrospective study and model-based economic evaluation.Setting Two urban tertiary referral maternity units, currently using risk factor-based screening for HCV infection.Population Pregnant women who had been tested for hepatitis B, HIV but not HCV.Methods Anonymised sera were tested for HCV antibody. Positive sera were tested for HCV antigen. A cost-effectiveness analysis of a change to universal screening was performed using a Markov model to simulate disease progression and Monte Carlo simulations for probabilistic sensitivity analysis. Main outcome measures Presence of HCV antigen and cost per quality-adjusted life year (QALY).Results In all, 4655 samples were analysed. Twenty had HCV antibodies and five HCV antigen. This gives an active infection rate of 5/4655, or 0.11%, compared with a rate of 0.15% in the risk-factor group. This prevalence is 65% lower than a previous study in the same hospitals from 2001 to 2005. The calculated incremental cost-effectiveness ratio (ICER) for universal screening was €3,315 per QALY gained. ConclusionThis study showed that the prevalence of HCV infection in pregnant women in the Dublin region has declined by 65% over the past two decades. Risk factor-based screening misses a significant proportion of infections. A change to universal maternal screening for hepatitis C would be cost-effective in our population.

Implementation of HCV screening in the 1969–1989 birth‐cohort undergoing COVID‐19 vaccination

“…In literature, examples of health economic analyses of HCV screening programmes in Europe were performed on high‐risk populations or specific target populations only (i.e. pregnant women, inmates) 19–22 . Results from these studies are discordant, and peculiar aspects of the national health systems, the target population and the cost per treatment in each context should be considered in terms of low generalizability of the results.…”

“…pregnant women, inmates). 19 , 20 , 21 , 22 Results from these studies are discordant, and peculiar aspects of the national health systems, the target population and the cost per treatment in each context should be considered in terms of low generalizability of the results. Furthermore, the cost per QALY gained in such analyses heavily depends on the prevalence of HCV infection (up to 16% in Irish inmates) and the cost of the screening programme.…”

Prevalence of Hepatitis C Virus among Hospitalized Patients in a Tertiary Hospital in Italy: The Basis for a National Screening Assessment Model?

“…Concerning the economical costs, examples of economic analyses of HCV screening programmes in Europe were performed on pregnant women or high-risk populations only [18][19][20][21]. So, peculiar aspects of the national health systems, the target population and the cost per treatment in each context should be considered in terms of low generalizability of the results.…”

Modelling the potential clinical and economic impact of universal antenatal hepatitis C (HCV) screening and providing treatment for pregnant women with HCV and their infants in Egypt: a cost-effectiveness study

“…HCV antibody-positive children are referred for HCV RNA testing and if positive are offered DAA treatment. 11 The cost-effectiveness of universal antenatal screening for HCV has been demonstrated in some high-income countries, [12][13][14] with limited data from low-income and middle-income countries with a high HCV burden. It is important to note that DAAs are not currently approved for use during pregnancy, breast feeding or for young children aged <3 years.…”