Cost-effectiveness of Antenatal Rescreening Among Pregnant Women for Hepatitis C in the United States

Abstract

To inform proposed changes in U.S. HCV screening guidelines, we assessed the cost-effectiveness of HCV antenatal rescreening for women without evidence of HCV during a prior pregnancy, using a previously published model. Universal HCV rescreening among pregnant women was cost-effective (ICER $6,000/QALY) and should be recommended nationally.

The impact of direct acting antivirals on hepatitis C virus disease burden and associated costs in four european countries

“…Base-case Parameter value used in the DSA [11] Standard error included in the PSA Source F0 to F1 0.117 0.113 0,010 [12] F1 to F2 0.085 0.113 0,007 [12] F2 to F3 0.120 0.113 0,010 [12] F3 to F4 0.100 0.113 0,009 [13] F4 to decompensated cirrhosis (DC) 0.030 0.041 0,003 [13] F4 to HCC 0.050 0.021 0,004 [13] Decompensated cirrhosis to HCC 0.100 0.014 0,009 [13] Decompensated cirrhosis to transplant 0.110 0.031 0,009 [13] HCC to transplant 0.200 0.031 0,017 [14] SVR to HCC a 0.008 0.009 0,000 Assumption from [15] SVR to transplant a 0.016 0.020 0,002 Assumption from [15]…”

“…The probabilities of progressing through the various stages of disease were based on the results of a literature review ( [11][12][13][14][15][16][17] As a certain proportion of patients with F3 fibrosis may in fact have undiagnosed F4 liver fibrosis (PITER data, not shown), 10% of patients that achieved an SVR in F3 were progressed in the model according to the transition probabilities of achieving SVR in stage F4. 18 All transition probabilities are adjusted for competing probabilities of death from other causes according to the official data from each country (Supporting Information Table A1).…”

Changing epidemiology, implications, and recommendations for hepatitis C in women of childbearing age and during pregnancy

“…32 In addition, the question of when to re-screen after initial screening during pregnancy is an important one, and recent evaluation has demonstrated costeffectiveness of rescreening in each subsequent pregnancy. 33 Internationally, the European Association for the Study of Liver Diseases 34 and the Asian Pacific Association for the Study of the Liver 35 have both recommended risk-based screening without updated recommendations for universal screening, and country-specific HCV prevalence and costeffectiveness may guide future decisions regarding recommendations for universal screening.…”

Letter: universal screening for hepatitis C in pregnant women, children and adolescents

“…Chaillon et al assessed the cost-effectiveness of offering HCV antenatal rescreening for women in the United States screened during a prior pregnancy and without evidence of past HCV exposure, using a previously published model. 6 They showed that universal HCV rescreening among pregnant women was cost-effective. Another argument to screening in each pregnancy is that an inordinate amount of time could be spent trying to assess whether a new patient in an obstetric practice had received her one-time HCV screening in a prior pregnancy.…”