Is Adding HCV Screening to the Antenatal National Screening Program in Amsterdam, The Netherlands, Cost-Effective?

Abstract

IntroductionHepatitis C virus (HCV) infection can lead to severe liver disease. Pregnant women are already routinely screened for several infectious diseases, but not yet for HCV infection. Here we examine whether adding HCV screening to routine screening is cost-effective.MethodsTo estimate the cost-effectiveness of implementing HCV screening of all pregnant women and HCV screening of first-generation non-Western pregnant women as compared to no screening, we developed a Markov model. For the parameters of the model, we used prevalence data from pregnant women retrospectively tested for HCV in Amsterdam, the Netherlands, and from literature sources. In addition, we estimated the effect of possible treatment improvement in the future.ResultsThe incremental costs per woman screened was €41 and 0.0008 life-years were gained. The incremental cost-effectiveness ratio (ICER) was €52,473 which is above the cost-effectiveness threshold of €50,000. For screening first-generation non-Western migrants, the ICER was €47,113. Best-case analysis for both scenarios showed ICERs of respectively €19,505 and €17,533. We estimated that if costs per treatment were to decline to €3,750 (a reduction in price of €31,000), screening all pregnant women would be cost-effective.ConclusionsCurrently, adding HCV screening to the already existing screening program for pregnant women is not cost-effective for women in general. However, adding HCV screening for first-generation non-Western women shows a modest cost-effective outcome. Yet, best case analysis shows potentials for an ICER below €20,000 per life-year gained. Treatment options will improve further in the coming years, enhancing cost-effectiveness even more.

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

“…Urbanus et al reported that screening for HCV in Amsterdam's antenatal population was not cost-effective [21]. Two aspects that differ between the Urbanus study and this study, are (a) the inclusion of relatively high costs associated with screening and treatment within the Dutch population, and (b) the inclusion of life-years within the ICER calculation rather than QALYs.…”

“…per QALY gained [19]; in the US, the threshold is $50,000 per QALY gained [20], and a previous European evaluation of an antenatal HCV screening programme applied a threshold of €20,000 to €50,000 [21].…”

Hepatitis C infection among pregnant women in central Poland: Significance of epidemiological anamnesis and impact of screening tests to detect infection

“…This group may only be detected through screening examinations. 24,25 In our study, 36.1% of women were diagnosed without presenting risk factors in the interview, physical examination, or laboratory results.…”

“…Because of its cost-effectiveness, universal/antenatal screening is primarily considered in populations in which the prevalence of anti-HCV is higher than 1-2%. 24,26,27 Such rates of infection significantly increase the risk of contact with HCV through casual sexual contact and non-sterile medical and non-medical procedures. Currently, the United States has implemented a routine examination for anti-HCV in people born 1945-1965, regardless of other risk factors.…”

Hepatitis C virus infection in children and adolescents

“…Current antenatal screening programs for HCV are not standard of care, and cost effectiveness is debated 26, 138, 139. However, strategies aimed at preventing perinatal transmission will be impactful.…”