BACKGROUND AND PURPOSE:

• SMFM recommends screening for hepatitis C in pregnancy in women who are at high risk (see ‘Related ObG Topics’ below)
• New medications can result in 95–99% Hepatitis C virus (HCV) cure
• Due to opioid epidemic, incidence of HCV is rising in younger individuals
• Tasillo et al. (Obstetrics & Gynecology, 2019) sought to determine the clinical effects and cost-effectiveness of universal prenatal hepatitis C screening using computer modeling

METHODS:

• Stochastic individual-level micro-simulation model to simulate the lifetimes of 250 million pregnant women
• Women were matched at baseline with the U.S. childbearing population for
  • Age
  • Injection drug use behaviors
  • Hepatitis C virus (HCV) infection status
• Modeled outcomes included
  • Hepatitis C diagnosis | Treatment | Cure | Lifetime health care costs | Quality-adjusted life years (QALY) | Incremental cost-effectiveness ratios comparing universal prenatal hepatitis C screening to current practice
• Authors also modeled the identification of neonates exposed to maternal HCV at birth

RESULTS:

• Universal prenatal hepatitis C screening compared to current practice resulted in
  • Pregnant women with hepatitis C infection living 1.21 years longer and 16% lower HCV-attributable mortality
  • an incremental cost-effectiveness ratio of $41,000 per QALY gained
• Incremental cost-effectiveness ratios remained below $100,000 per QALY gained in most additional analyses
  • Notable exceptions included
    • Incremental cost-effectiveness ratios above $100,000 when assuming mean time to cirrhosis of 70 years
    • A cost greater than $500,000 per false positive diagnosis
    • Population HCV infection prevalence below 0.16%
  • Universal prenatal hepatitis C screening increased identification of neonates exposed to HCV at birth from 44% to 92%

CONCLUSION:

• Universal prenatal hepatitis C screening would result in
  • Improved health outcomes in women with HCV infection
  • Improved identification of at risk HCV-exposed newborns
• The authors demonstrated that universal hepatitis C screening is cost effective and further state

Universal prenatal HCV testing should be considered in plans for the elimination of viral hepatitis C as a public health threat.

Learn More – Primary Sources:

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

Related ObG Topics:

SMFM Releases Guidelines on Screening and Management of Hepatitis C in Pregnancy 

STI Screening in Pregnancy: CDC Recommendations

What is the Effect of Hepatitis C on Fertility and Pregnancy Outcomes?