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

Tasillo, Abriana, BA; Eftekhari Yazdi, Golnaz, MSc; Nolen, Shayla, MPH; Schillie, Sarah, MD, MPH; Vellozzi, Claudia, MD, MPH; Epstein, Rachel, MD, MA; Randall, Liisa, PhD; Salomon, Joshua A., PhD; Linas, Benjamin P., MD, MPH

doi: 10.1097/AOG.0000000000003062
Contents: Infectious Disease: Original Research

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 comparing universal prenatal hepatitis C screening to current practice. We modeled whether neonates exposed to maternal HCV at birth were identified as such.

RESULTS: Pregnant women with hepatitis C infection lived 1.21 years longer and had 16% lower HCV-attributable mortality with universal prenatal hepatitis C screening, which had an incremental cost-effectiveness ratio of $41,000 per QALY gained compared with current practice. Incremental cost-effectiveness ratios remained below $100,000 per QALY gained in most sensitivity analyses; notable exceptions included incremental cost-effectiveness ratios 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 neonates exposed to HCV at birth from 44% to 92%.

CONCLUSIONS: In our model, universal prenatal hepatitis C screening improves health outcomes in women with HCV infection, improves identification of HCV exposure in neonates born at risk, and is cost-effective.

Universal testing for hepatitis C in pregnancy is cost-effective and would increase average life expectancy by 1.21 years for women with the infection.

Boston Medical Center, Section of Infectious Diseases, Boston, Massachusetts; the Centers for Disease Control and Prevention, Division of Viral Hepatitis, Atlanta, Georgia; Boston Medical Center, Section of Infectious Diseases, Section of Pediatric Infectious Diseases; and the Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts; and Stanford University, Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford, California.

Corresponding author: Abriana Tasillo, Boston Medical Center, Section of Infectious Diseases, 801 Massachusetts Avenue Boston, MA 02119; email: abriana.tasillo@bmc.org.

This project was funded by the CDC, National Center for HIV, Viral Hepatitis, STD, and TB Prevention Epidemiologic and Economic Modeling Agreement (NEEMA, # 5U38PS00-4644) and the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV and HIV (NIDA, #P30DA040500). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at http://links.lww.com/AOG/B242.

Received September 07, 2018

Received in revised form November 06, 2018

Accepted November 08, 2018

© 2019 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.