1Department of Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK. Electronic address: firstname.lastname@example.org.
2Health Economics and Outcomes Research Limited, Wales, UK.
3University College London Institute of Child Health, London, UK.
4Department of Gastroenterology and Hepatology, Kingston Hospital NHS Foundation Trust, UK.
5Department of Paediatrics, St Mary's Hospital Campus, Imperial College, UK.
6Department of Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Hepatology, St Mary's Hospital Campus, Imperial College, UK.
7Health Economics and Outcomes Research Limited, Wales, UK; Swansea Centre for Health Economics, Swansea University, Wales UK.
8Department of Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
This study aims to assess the cost-effectiveness of a routine universal antenatal hepatitis C virus (HCV) screening programme at a London centre.
Ten years' retrospective antenatal screening and outcome data informed a cost-effectiveness analysis using the previously validated MONARCH model. The cost and quality-of-life outcomes associated with the screening and treatment of newly identified hepatitis C cases were used to generate cost-effectiveness estimates for the screening programme.
A total of 35,355 women were screened between 1st November 2003 and 1st March 2013; 136 women (0.38%) were found to be HCV antibody positive. Of 78 (0.22%) viraemic cases, 44 (0.12%) were newly diagnosed. In addition, the screening programme identified three (6.8%) vertical transmissions in children of newly diagnosed mothers. Of 16 newly diagnosed mothers biopsied, all were in the F0-F2 METAVIR disease stages, and 50% had HCV genotype 1. Postnatal treatment with pegylated interferon and ribavirin was initiated in 19 women, with 14 (74%) achieving sustained virologic response. The total cost of screening and confirmation of diagnoses was estimated to be £240,641. This translates to £5,469 per newly diagnosed individual. The incremental cost-effectiveness ratio of this screening and treatment strategy was £2,400 per QALY gained. Treatment with newer direct acting antiviral regimens would have a projected cost of £9,139 per QALY gained, well below the £20,000-30,000/QALY gained willingness-to-pay threshold applied by policy advisory bodies.
This study demonstrates that an antenatal screening and treatment programme is feasible and effective, at a cost considered acceptable.