Short-Term Effects and Long-Term Cost-Effectiveness of Universal Hepatitis C Testing in Prenatal Care

Abstract

Objective-To estimate the clinical effects and cost-effectiveness of universal prenatal hepatitis C screening, and to calculate potential life expectancy, quality of life, and health care costs associated with universal prenatal hepatitis C screening and linkage to treatment. Methods-Using a stochastic individual-level microsimulation model, we simulated the lifetimes of 250 million pregnant women matched at baseline with the U.S. childbearing population on age, injection drug use behaviors, and hepatitis C virus (HCV) infection status. Modeled outcomes included hepatitis C diagnosis, treatment and cure, lifetime health care costs, quality-adjusted life years (QALY) and incremental cost-effectiveness ratios (ICERs) comparing universal prenatal hepatitis C screening to current practice. We modeled whether infants exposed to maternal hepatitis C virus (HCV) at birth were identified as such. Results-Hepatitis C virus-infected pregnant women lived 1.21 years longer and had 16% lower HCV-attributable mortality with universal prenatal hepatitis C screening, which had an ICER of $41,000 per QALY gained compared to current practice. Incremental cost-effectiveness ratios remained below $100,000 per QALY gained in most sensitivity analyses; notable exceptions included ICERs above $100,000 when assuming mean time to cirrhosis of 70 years, a cost greater than $500,000 per false positive diagnosis, or population HCV infection prevalence below 0.16%. Universal prenatal hepatitis C screening increased identification of infants exposed to HCV at birth from 44% to 92%. Conclusions-In our model, universal prenatal hepatitis C screening improves health outcomes in HCV-infected women, improves identification of HCV exposure in infants born at risk, and is cost-effective. PRÉCIS Universal testing for hepatitis C in pregnancy is cost effective and would increase average life expectancy by 1.21 years for infected women.

EASL recommendations on treatment of hepatitis C: Final update of the series☆

“…Models have shown that universal prenatal HCV screening improves health outcomes in women with HCV infection, improves identification of HCV in at-risk neonates, and is costeffective. 263 Screening remained cost-effective at a prevalence of 0.07%, which is translatable to a European population. 264 Universal HCV testing in pregnant women is therefore recommended as part of the strategy for global elimination.…”

Hepatitis C Virus Infection in Children and Pregnant Women: An Updated Review of the Literature on Screening and Treatments

“…56 Moreover, recent models of Pharmacoeconomics suggest that the adoption of universal screening for HCV in prenatal care would have undoubted advantages on the outcome of mother, newborn and is a cost-effective practice. 57 In women of childbearing age who are infected with HCV, antiviral treatment prior to pregnancy can improve maternal health and eliminate the risk of MTCT. Prevention of MTCT is limited by the absence of universal guidelines for HCV screening during pregnancy.…”

CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020

“…Although real-world data informing screening during each pregnancy are lacking, a modeled analysis suggests that hepatitis C screening during each pregnancy would be costeffective. Using a hepatitis C prevalence of 0.38% among pregnant women, as determined from national birth certificate data, the analysis found that universal hepatitis C screening during the first trimester of each pregnancy under a health care perspective compared with the current practice of risk-based screening had an ICER of $41,000/QALY gained (93). The model assumed no hepatitis C treatment would be offered until after 6 months postpartum and that 25% of women would be linked to care, with 92% of those linked initiating treatment.…”