Cost-effectiveness of hepatitis C virus screening, and subsequent monitoring or treatment among pregnant women in the Netherlands

Abstract

Background The prevalence of diagnosed chronic hepatitis C virus (HCV) infection among pregnant women in the Netherlands is 0.26%, yet many cases remain undiagnosed. HCV screening and treatment of pregnant HCV carriers could reduce the burden of disease and limit vertical transmission from mother to child. We assessed the impact of HCV screening and subsequent treatment with new direct-acting antivirals (DAAs) among pregnant women in the Netherlands. Methods An HCV natural history Markov transition state model was developed, to evaluate the public-health and economic impact of HCV screening and treatment. Besides all 179,000 pregnant women in the Netherlands (cohort 1), we modelled 3 further cohorts: all 79,000 first-time pregnant women (cohort 2), 33,000 pregnant migrant women (cohort 3) and 16,000 first-time pregnant migrant women (cohort 4). Each cohort was analyzed in various scenarios: i no intervention, i.e., the current practice, ii screen-and-treat, i.e., the most extensive approach involving treatment of all individuals found HCV-positive, and iii screen-and-treat/monitor, i.e., a strategy involving treatment of symptomatic (F1–F4) patients and follow-up of asymptomatic (F0) HCV carriers with subsequent treatment only at progression. Results For all cohorts, comparison between scenarios (ii) and (i) resulted in ICERs between €9,306 and €10,173 per QALY gained and 5 year budget impacts varying between €6,283,830 and €19,220,405. For all cohorts, comparison between scenarios (iii) and (i) resulted in ICERs between €1,739 and €2,749 per QALY gained and budget impacts varying between €1,468,670 and €5,607,556. For all cohorts, the ICERs (scenario iii versus ii) involved in delayed treatment of asymptomatic (F0) HCV carriers varied between €56,607 and €56,892, well above the willingness-to-pay (WTP) threshold of €20,000 per QALY gained and even above a threshold of €50,000 per QALY gained. Conclusion Universal screening for HCV among all pregnant women in the Netherlands is cost-effective. However, it would be reasonable to consider smaller risk groups in view of the budget impact of the intervention.

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.…”

Pragmatic Experience with Risk-based versus Universal Hepatitis C Screening in Pregnancy: Detection of Infection and Postpartum Linkage to Care

“…[18][19][20][21] However, since this publication, more contemporary analysis suggests cost-effectiveness of universal screening for HCV in pregnancy, prompting further evaluation of screening modality of HCV in pregnancy. 25,26 Despite increasing prevalence of HCV infection in young women, risk-based screening for HCV in pregnancy remains the recommended practice by SMFM and ACOG. Although some practices like ours have adopted universal screening for HCV in pregnancy, many practitioners use risk-based screening for HCV in pregnancy based on these recommendations.…”

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.…”