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J Hepatol. 2015 Oct;63(4):797-804. doi: 10.1016/j.jhep.2015.05.015. Epub 2015 May 27.

Is antenatal screening for hepatitis C virus cost-effective? A decade's experience at a London centre.

Author information

1
Department of Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Hepatology, Imperial College, UK. Electronic address: nowlan.selvapatt@imperial.nhs.uk.
2
Health Economics and Outcomes Research Limited, Wales, UK.
3
University College London Institute of Child Health, London, UK.
4
Department of Gastroenterology and Hepatology, Kingston Hospital NHS Foundation Trust, UK.
5
Section of Paediatrics, St Mary's Hospital Campus, Imperial College, UK.
6
Department of Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Hepatology, Imperial College, UK.
7
Health Economics and Outcomes Research Limited, Wales, UK; Swansea Centre for Health Economics, Swansea University, Wales, UK.
8
Department of Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.

Abstract

BACKGROUND & AIMS:

This study aims to assess the cost-effectiveness of a routine universal antenatal hepatitis C virus (HCV) screening programme at a London centre.

METHODS:

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.

RESULTS:

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 £5469 per newly diagnosed individual. The incremental cost-effectiveness ratio of this screening and treatment strategy was £2400 per QALY gained. Treatment with newer direct-acting antiviral regimens would have a projected cost of £9139 per QALY gained, well below the £20,000-30,000/QALY gained willingness-to-pay threshold applied by policy advisory bodies.

CONCLUSIONS:

This study demonstrates that an antenatal screening and treatment programme is feasible and effective, at a cost considered acceptable.

KEYWORDS:

Antenatal; Cost-effectiveness; Hepatitis C; MONARCH; Pregnancy; Screening

PMID:
26024832
DOI:
10.1016/j.jhep.2015.05.015
[Indexed for MEDLINE]

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