Is Universal Prenatal HCV Screening Cost-Effective?
BACKGROUND AND PURPOSE:
Chronic prevalence of Hepatitis C Virus (HCV) among pregnant women doubled in the United States between 2009-2014
Many more cases remain undiagnosed
There is controversy among professional bodies regarding HCV screening in pregnancy
SMFM/ACOG and CDC recommend a risk-based approach (see ‘Related ObG Topics’ below)
New AASLD/IDSA guidelines recommend a universal approach
Kentucky legislature has recommended universal screening based on HCV disease burden
Chaillon et al. (Clinical Infectious Diseases 2019) sought to determine whether the universal approach to HCV screening in pregnancy is cost-effective in the US population
Cost-effectiveness analysis (using HCV natural history Markov model) was performed from a public sector healthcare payer perspective comparing
Universal prenatal HCV screening followed by treatment after pregnancy vs
Current risk-based approach
A 0.73% HCV chronic prevalence among pregnant women was assumed based on national data
Main analysis: Assumed no Medicaid reimbursement restrictions by fibrosis stage at baseline
In addition, investigators did assess different scenarios based on treatment eligibility
Cost effectiveness methods and calculations based on the following
Health outcomes: Quality-adjusted life years (QALYs) over lifetime
HCV drug costs: $25,000/treatment
Mean incremental cost-effectiveness ratios (ICERs)
Cost effectiveness: Willingness to pay threshold of $50,000/QALY gained
Analysis included the following
State-based differences in prevalence | Baseline fibrosis rate distribution | HCV screening uptake
Projections regarding national impact if universal screening was implemented nationwide was also investigated
Consideration given to newborns who would be detected at birth via universal screening based on 5.8% vertical HCV transmission rate and 16% pediatric follow up rates (at 18 months)
Universal screening was cost-effective in all treatment eligibility scenarios
Mean ICER <$3,000/QALY gained
Comparing universal to risk-based screening (per pregnant woman screened)
Incremental costs: $53.2
Incremental increase in QALYs of 0.019
At lowest estimated prevalence (Hawaii) of 0.07%, universal screening was still cost-effective
May be cost effective down to 0.04% chronic HCV prevalence
Screening the approximately 5.8 million pregnant women (2018) would have potentially benefited 33,000 women based on current fibrosis restrictions
The authors state that based on the results of
As such, our results support calls for a change of SMFM/ACOG and CDC guidelines to recommend universal HCV screening of pregnant women. Our results also provide additional economic evidence in support of the updated AASLD/IDSA guidelines and Kentucky legislation recommending screening pregnant women.
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