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#Grand Rounds

Is Universal Prenatal HCV Screening Cost-Effective?

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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

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Related ObG Topics:

Is it Time for Universal Prenatal Hepatitis C Screening?
SMFM Releases Guidelines on Screening and Management of Hepatitis C in Pregnancy 
What is the Effect of Hepatitis C on Fertility and Pregnancy Outcomes?

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