1 Division of Infectious Diseases and Global Public Health, University of California San Diego, CA.
2 Perelman School of Medicine, University of Pennsylvania, PA.
3 Department of Internal Medicine, Rush University Medical Center, IL.
4 Population Health Sciences, University of Bristol, UK.
BACKGROUND: Hepatitis C Virus (HCV) chronic prevalence among pregnant women in the United States (U.S.) U.S. doubled nationally from 2009-2014 (~0.7%), yet many remain undiagnosed. Screening pregnant women is not recommended by the Society of Maternal-Fetal Medicine or the Centers for Disease Control and Prevention, despite new AASLD/IDSA guidelines recommending screening this group. We assessed the cost-effectiveness of HCV screening for pregnant women in the U.S.
METHODS: An HCV natural history Markov model was used to evaluate the cost-effectiveness of universal HCV screening of pregnant women followed by treatment after pregnancy compared to background risk-based screening from a health care payer perspective. We assumed 0.73% HCV chronic prevalence among pregnant women based on national data. We assume no Medicaid reimbursement restrictions by fibrosis stage at baseline, but explore differing restrictions in sensitivity analyses. We assessed cost (in USD$) and health outcomes (in quality-adjusted life years, QALYs) over a lifetime horizon, using new HCV drug costs of $25,000/treatment. We assess mean incremental cost-effectiveness ratios (ICERs) under a willingness to pay threshold of $50,000/QALY gained. We additionally evaluate potential population impact.
RESULTS: Universal antenatal screening was cost-effective in all treatment eligibility scenarios (mean ICER <$3,000/QALY gained). Screening remained cost-effective at 0.07% prevalence, the lowest estimated prevalence state in the U.S. (Hawaii). Screening the ~5.04 million pregnant women in 2018 could result in detection and treatment of 33,000 women based on current fibrosis restrictions.
CONCLUSIONS: Universal screening for HCV among pregnant women in the U.S. is cost effective and should be recommended nationally.