Cost-effectiveness of hepatitis C virus screening, and subsequent monitoring or treatment among pregnant women in the Netherlands

Job F. H. Eijsink*, Mohamed N. M. T. Al Khayat, Cornelis Boersma, Peter G. J. ter Horst, Jan C. Wilschut, Maarten J. Postma

*Corresponding author for this work

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Abstract

Background The prevalence of diagnosed chronic hepatitis C virus (HCV) infection among pregnant women in the Netherlands is 0.26%, yet many cases remain undiagnosed. HCV screening and treatment of pregnant HCV carriers could reduce the burden of disease and limit vertical transmission from mother to child. We assessed the impact of HCV screening and subsequent treatment with new direct-acting antivirals (DAAs) among pregnant women in the Netherlands. Methods An HCV natural history Markov transition state model was developed, to evaluate the public-health and economic impact of HCV screening and treatment. Besides all 179,000 pregnant women in the Netherlands (cohort 1), we modelled 3 further cohorts: all 79,000 first-time pregnant women (cohort 2), 33,000 pregnant migrant women (cohort 3) and 16,000 first-time pregnant migrant women (cohort 4). Each cohort was analyzed in various scenarios:i no intervention, i.e., the current practice,ii screen-and-treat, i.e., the most extensive approach involving treatment of all individuals found HCV-positive, andiii screen-and-treat/monitor, i.e., a strategy involving treatment of symptomatic (F1-F4) patients and follow-up of asymptomatic (F0) HCV carriers with subsequent treatment only at progression. Results For all cohorts, comparison betweenscenarios(ii) and (i) resulted in ICERs between euro9,306 and euro10,173 per QALY gained and 5 year budget impacts varying between euro6,283,830 and euro19,220,405. For all cohorts, comparison betweenscenarios(iii) and (i) resulted in ICERs between euro1,739 and euro2,749 per QALY gained and budget impacts varying between euro1,468,670 and euro5,607,556. For all cohorts, the ICERs (scenario iiiversusii) involved in delayed treatment of asymptomatic (F0) HCV carriers varied between euro56,607 and euro56,892, well above the willingness-to-pay (WTP) threshold of euro20,000 per QALY gained and even above a threshold of euro50,000 per QALY gained. Conclusion Universal screening for HCV among all pregnant women in the Netherlands is cost-effective. However, it would be reasonable to consider smaller risk groups in view of the budget impact of the intervention.

Original languageEnglish
Pages (from-to)75-88
Number of pages14
JournalEuropean Journal of Health Economics
Volume22
Issue number1
Early online date2020
DOIs
Publication statusPublished - Feb-2021

Keywords

  • Hepatitis C virus
  • Pregnant women
  • HCV screening
  • Direct-acting antivirals
  • HCV VERTICAL TRANSMISSION
  • NATURAL-HISTORY
  • PLUS RIBAVIRIN
  • IMPACT
  • ERA
  • POPULATION
  • PREVALENCE
  • MANAGEMENT
  • MIGRANTS
  • BENEFITS

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