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

METHODS:

• 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
  • Cost: USD$
  • Health outcomes: Quality-adjusted life years (QALYs) over lifetime
  • HCV drug costs: $25,000/treatment
• Mean incremental cost-effectiveness ratios (ICERs)
  • $/QALY gained
• 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)

RESULTS:

• 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

CONCLUSION:

• The authors state that based on the results of this study

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.

Learn more – Primary Sources:

Cost-Effectiveness of Universal Hepatitis C Virus Screening of Pregnant Women in The United States

Related ObG Topics: