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

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• 作者：Nowlan Selvapatt¹ ; ² ; ^{nowlan.selvapatt@imperial.nhs.uk" class="auth_mail" title="E-mail the corresponding author} ; Thomas Ward³ ; Heather Bailey⁴ ; Hayley Bennett³ ; Claire Thorne⁴ ; Lay-May See⁵ ; Gareth Tudor-Williams⁶ ; Mark Thursz¹ ; ² ; Phil McEwan³ ; ⁷ ; Ashley Brown¹
• 关键词：HCV ; hepatitis C virus ; ESLD ; end stage liver disease ; HCC ; hepatocellular carcinoma ; DAA ; direct acting antiviral ; HBV ; hepatitis B virus ; REDCAP ; research electronic data capture ; MONARCH ; modelling the natural history and cost-effectiveness of hepatitis C ; QALY ; quality adjusted life year ; SVR ; sustained virologic response ; eRVR ; extended rapid virologic response ; SA ; sensitivity analysis ; BC ; base case ; ICER ; incremental cost-effectiveness ratio
• 刊名：Journal of Hepatology
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：63
• 期：4
• 页码：797-804
• 全文大小：928 K

文摘

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.