Universal prenatal hepatitis C virus (HCV) screening was found to be cost-effective and improved health outcomes in women diagnosed with HCV infection and identification of HCV exposure in neonates, according to a study published in Obstetrics & Gynecology.
A research team used a stochastic microsimulation model to analyze the health outcomes and cost-effectiveness of universal testing for HCV infection during prenatal care. Lifetimes of 250 million pregnant women matched at baseline with the US population on age, injection use behaviors, and HCV infection status were simulated. Two scenarios were considered: current practice screening of a small percentage of women during prenatal care, and universal testing for HCV infection at the first clinical encounter for each pregnancy.
HCV disease progression was modeled according to stages of liver fibrosis as categorized by METAVIR scores. HCV testing was modeled at the first prenatal visit with serum HCV antibody testing followed by HCV RNA testing. Treatment was modeled with a 12-week regimen based on sofosbuvir and velpatasvir for those with cirrhosis and an 8-week regimen of glecaprevir and pibrentasvir for those without cirrhosis. Clinical trial and real-world effectiveness data were used to determine treatment adherence and sustained virologic response rates between 93% and 99% depending on HCV genotype and stage of fibrosis. Age-stratified healthcare costs were estimated using the Medicare Reimbursement Fee Schedule.