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Short-term Effects and Long-term Cost-Effectiveness of Universal Hepatitis C Testing in Prenatal Care
  • Published Date:
    Feb 2019
  • Source:
    Obstet Gynecol. 133(2):289-300
  • Language:
    English


Public Access Version Available on: February 01, 2020 information icon
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  • Pubmed ID:
    30633134
  • Pubmed Central ID:
    PMC6501827
  • Description:
    Objective

    To estimate the clinical effects and cost-effectiveness of universal prenatal hepatitis C screening, and to calculate potential life expectancy, quality of life, and health care costs associated with universal prenatal hepatitis C screening and linkage to treatment.

    Methods

    Using a stochastic individual-level microsimulation model, we simulated the lifetimes of 250 million pregnant women matched at baseline with the U.S. childbearing population on age, injection drug use behaviors, and hepatitis C virus (HCV) infection status. Modeled outcomes included hepatitis C diagnosis, treatment and cure, lifetime health care costs, quality-adjusted life years (QALY) and incremental cost-effectiveness ratios (ICERs) comparing universal prenatal hepatitis C screening to current practice. We modeled whether infants exposed to maternal hepatitis C virus (HCV) at birth were identified as such.

    Results

    Hepatitis C virus–infected pregnant women lived 1.21 years longer and had 16% lower HCV-attributable mortality with universal prenatal hepatitis C screening, which had an ICER of $41,000 per QALY gained compared to current practice. Incremental cost-effectiveness ratios remained below $100,000 per QALY gained in most sensitivity analyses; notable exceptions included ICERs above $100,000 when assuming mean time to cirrhosis of 70 years, a cost greater than $500,000 per false positive diagnosis, or population HCV infection prevalence below 0.16%. Universal prenatal hepatitis C screening increased identification of infants exposed to HCV at birth from 44% to 92%.

    Conclusions

    In our model, universal prenatal hepatitis C screening improves health outcomes in HCV-infected women, improves identification of HCV exposure in infants born at risk, and is cost-effective.

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