Short-term Effects and Long-term Cost-Effectiveness of Universal Hepatitis C Testing in Prenatal Care

Details

• Alternative Title:
  Obstet Gynecol
• Personal Author:
  Tasillo, Abriana ; Yazdi, Golnaz Eftekhari ; Nolen, Shayla ; Schillie, Sarah ; Vellozzi, Claudia ; Epstein, Rachel ; Randall, Liisa ; Salomon, Joshua A. ; Linas, Benjamin P.
• 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.
  
  
• Subjects:
  Cost-Benefit Analysis Female Hepatitis C Humans Mass Screening Models, Theoretical Pregnancy Prenatal Care
• Source:
  Obstet Gynecol. 133(2):289-300
• Pubmed ID:
  30633134
• Pubmed Central ID:
  PMC6501827
• Document Type:
  Journal Article
• Funding:
  U38 PS004644/PS/NCHHSTP CDC HHSUnited States/ ; P30 DA040500/DA/NIDA NIH HHSUnited States/ ; T32 AI052074/AI/NIAID NIH HHSUnited States/ ; P30 AI042853/AI/NIAID NIH HHSUnited States/ ; R01 DA031059/DA/NIDA NIH HHSUnited States/
• Volume:
  133
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:93f1cac20f7b932fd11cfdf745ded23f21675bbfba140b5f3b797762c3f34f11e64efee75bef43ed3ca3172be14407778a8a77414cd78219ecfab97d94ebeccc
• Download URL:
  https://stacks.cdc.gov/view/cdc/78356/cdc_78356_DS1.pdf
• File Type:
  [PDF - 416.33 KB ]