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

Selvapatt, N; Ward, T; Bailey, H; Bennett, H; Thorne, C; See, L-M; Tudor-Williams, G; ... Brown, A; + view all (2015) Is antenatal screening for hepatitis C virus cost-effective? A decade's experience at a London centre. Journal of Hepatology , 63 (4) pp. 797-804. 10.1016/j.jhep.2015.05.015. Green open access

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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.

Type: Article
Title: Is antenatal screening for hepatitis C virus cost-effective? A decade's experience at a London centre
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.jhep.2015.05.015
Publisher version: http://dx.doi.org/10.1016/j.jhep.2015.05.015
Language: English
Additional information: Copyright © 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. This manuscript version is made available under a Creative Commons Attribution Non-commercial Non-derivative 4.0 International license (CC BY-NC-ND 4.0). This license allows you to share, copy, distribute and transmit the work for personal and non-commercial use providing author and publisher attribution is clearly stated. Further details about CC BY licenses are available at https://creativecommons.org/licenses/. Access may be initially restricted by the publisher.
Keywords: Science & Technology, Life Sciences & Biomedicine, Gastroenterology & Hepatology, Antenatal, Pregnancy, Screening, Hepatitis C, Cost-effectiveness, MONARCH, INJECTING DRUG-USERS, PREGNANT-WOMEN, ECONOMIC-EVALUATION, UTILITY ANALYSIS, RIBAVIRIN, INFECTION, PEGINTERFERON-ALPHA-2A, IDENTIFICATION, TRANSMISSION, METAANALYSIS
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Population, Policy and Practice Dept
URI: https://discovery.ucl.ac.uk/id/eprint/1488938
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