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. Horst, Jan C. Wilschut and Maarten J. Postma
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Job F. H. Eijsink: Groningen Research Institute Pharmacy, University of Groningen
Mohamed N. M. T. Al Khayat: Groningen Research Institute Pharmacy, University of Groningen
Cornelis Boersma: University of Groningen
Peter G. J. Horst: Isala
Jan C. Wilschut: University of Groningen
Maarten J. Postma: Groningen Research Institute Pharmacy, University of Groningen

The European Journal of Health Economics, 2021, vol. 22, issue 1, No 6, 75-88

Abstract: 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, and iii 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 between scenarios (ii) and (i) resulted in ICERs between €9,306 and €10,173 per QALY gained and 5 year budget impacts varying between €6,283,830 and €19,220,405. For all cohorts, comparison between scenarios (iii) and (i) resulted in ICERs between €1,739 and €2,749 per QALY gained and budget impacts varying between €1,468,670 and €5,607,556. For all cohorts, the ICERs (scenario iii versus ii) involved in delayed treatment of asymptomatic (F0) HCV carriers varied between €56,607 and €56,892, well above the willingness-to-pay (WTP) threshold of €20,000 per QALY gained and even above a threshold of €50,000 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.

Keywords: Hepatitis C virus; Pregnant women; HCV screening; Direct-acting antivirals (search for similar items in EconPapers)
JEL-codes: C00 C02 C3 C30 C31 H00 H61 I00 I1 I10 I19 (search for similar items in EconPapers)
Date: 2021
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DOI: 10.1007/s10198-020-01236-2

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