Is it Time for Universal Prenatal Hepatitis C Screening?
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
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
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
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%
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.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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