Reuters Health Information (2005-05-04): Routine HCV screening in pregnancy not cost effective
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.