Reuters Health Information (2004-10-05): Elective Cesarean cost effective for women with HIV and hepatitis C
Elective Cesarean cost effective for women with HIV and hepatitis C
Last Updated: 2004-10-05 9:56:40 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Elective Cesarean delivery
(C-section) is cost effective in preventing vertical hepatitis C (HCV)
transmission in women coinfected with HIV, according to a report in the
September 3rd issue of AIDS.
C-section significantly protects against HCV transmission by
HIV/HCV-coinfected women, the authors explain. Antiviral therapy to
prevent maternal HCV transmission is not an option because ribavirin
and pegylated alfa-interferon (the standard treatment for chronic HCV)
cannot be used during pregnancy.
Dr. Bruce R. Schackman from the Weill Medical College of Cornell
University, New York and colleagues used a decision analytic model to
investigate the net health consequences, costs, and cost-effectiveness
of elective C-section to prevent perinatal transmission of HCV in
coinfected women with suppressed HIV RNA but detectable HCV RNA.
In the first scenario (assuming 50% spontaneous HCV clearance in
vertically infected infants), C-section resulted in an increase in 0.24
quality-adjusted life-years (QALY) per child and a loss of 0.02 QALY
per mother at an incremental cost-effectiveness ratio of $6100/QALY for
the net gain in QALY, the authors report.
In the second scenario (assuming 25% spontaneous HCV clearance in
vertically infected infants), C-section was associated with an increase
in 0.36 QALY per child and a loss of 0.02 QALY per mother, for an
incremental cost-effectiveness ratio of $3900/QALY for the larger net
gain in QALY.
The cost-effectiveness varied widely between high-cost and low-cost
health settings, the researchers note, ranging from $2000/QALY for the
second scenario in a low-cost setting to $9100/QALY for the first
scenario in a high-cost practice setting.
"C-section may still be indicated for some HIV-infected pregnant
women, even if they successfully control their HIV with
antiretrovirals," Dr. Schackman told Reuters Health. "These women must
be tested for HCV, and they need to receive education about the risk of
HCV transmission, the consequences of having an infant infected with
HCV, and the potential benefits and risks of an elective C-section to
reduce the likelihood of perinatal HCV transmission."
"There have been some studies that suggest that mothers with higher
HCV viral loads are more likely to transmit HCV to their infants during
vaginal deliveries," Dr. Schackman added. "This would indicate that
there may be some threshold HCV load below which a C-section would no
longer provide additional benefit."
"In the absence of definitive studies, however, we believe it would
be prudent to offer C-section to all HCV detectable/HIV undetectable
coinfected women who are not participating in prospective clinical