Economic

Routine HCV screening in pregnancy not cost effective

Last Updated: 2005-05-04 16:15:33 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Routine screening of pregnant women for hepatitis C virus (HCV) is not cost-effective, researchers from the Northwestern University Feinberg School of Medicine report in the April issue of the American Journal of Obstetrics and Gynecology.

The Chicago team developed a decision tree with Markov analysis to compare three approaches to asymptomatic HCV infection in pregnant women at low risk for HCV infection. These included no HCV screening; HCV screening and subsequent treatment for progressive disease; and HCV screening, subsequent treatment for progressive disease, and elective cesarean section to avert perinatal transmission.

According to Dr. Beth A. Plunkett and colleagues, screening pregnant women for HCV and subsequent treatment was not cost effective.

"Even under circumstances that we might consider to favor screening (such as when the prevalence of the disease is high or the efficacy of treatment is improved), the intervention does not become cost effective," they report.

The three-pronged approach -- HCV screening, treatment of progressive disease and elective cesarean delivery to avert perinatal transmission -- also failed to approach the team's cost-effectiveness threshold of $50,000 per quality-adjusted life year (QALY), "a commonly used threshold in research studies."

"HCV infection remains a significant public health issue that affects both mothers and their infants alike," Dr. Plunkett and colleagues write. "Unfortunately, our ability to treat or cure the disease is relatively limited."

"Consequently, as our model demonstrates, a screening strategy is not a cost-effective intervention even in the unique circumstances of pregnancy, when two individuals potentially could access the benefits of treatment and one individual could even avoid the disease altogether," they add.

Therefore, at present, the current standard of care (no screening) "is the most cost-effective option," they conclude.

Am J Obstet Gynecol 2005;192:1153-1161.