Nowlan Selvapatt1, Thomas Ward2, Heather Bailey3, Hayley Bennett2, Claire Thorne3, Lay-May See4, Gareth Tudor-Williams5, Mark Thursz6, Phil McEwan7, Ashley Brown8. 1. Department of Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Hepatology, Imperial College, UK. Electronic address: nowlan.selvapatt@imperial.nhs.uk. 2. Health Economics and Outcomes Research Limited, Wales, UK. 3. University College London Institute of Child Health, London, UK. 4. Department of Gastroenterology and Hepatology, Kingston Hospital NHS Foundation Trust, UK. 5. Section of Paediatrics, St Mary's Hospital Campus, Imperial College, UK. 6. Department of Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Hepatology, Imperial College, UK. 7. Health Economics and Outcomes Research Limited, Wales, UK; Swansea Centre for Health Economics, Swansea University, Wales, UK. 8. Department of Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
Abstract
BACKGROUND & AIMS: This study aims to assess the cost-effectiveness of a routine universal antenatal hepatitis C virus (HCV) screening programme at a London centre. METHODS: Ten years' retrospective antenatal screening and outcome data informed a cost-effectiveness analysis using the previously validated MONARCH model. The cost and quality of life outcomes associated with the screening and treatment of newly identified hepatitis C cases were used to generate cost-effectiveness estimates for the screening programme. RESULTS: A total of 35,355 women were screened between 1st November 2003 and 1st March 2013; 136 women (0.38%) were found to be HCV antibody positive. Of 78 (0.22%) viraemic cases, 44 (0.12%) were newly diagnosed. In addition, the screening programme identified three (6.8%) vertical transmissions in children of newly diagnosed mothers. Of 16 newly diagnosed mothers biopsied, all were in the F0-F2 METAVIR disease stages, and 50% had HCV genotype 1. Postnatal treatment with pegylated interferon and ribavirin was initiated in 19 women, with 14 (74%) achieving sustained virologic response. The total cost of screening and confirmation of diagnoses was estimated to be £240,641. This translates to £5469 per newly diagnosed individual. The incremental cost-effectiveness ratio of this screening and treatment strategy was £2400 per QALY gained. Treatment with newer direct-acting antiviral regimens would have a projected cost of £9139 per QALY gained, well below the £20,000-30,000/QALY gained willingness-to-pay threshold applied by policy advisory bodies. CONCLUSIONS: This study demonstrates that an antenatal screening and treatment programme is feasible and effective, at a cost considered acceptable.
BACKGROUND & AIMS: This study aims to assess the cost-effectiveness of a routine universal antenatal hepatitis C virus (HCV) screening programme at a London centre. METHODS: Ten years' retrospective antenatal screening and outcome data informed a cost-effectiveness analysis using the previously validated MONARCH model. The cost and quality of life outcomes associated with the screening and treatment of newly identified hepatitis C cases were used to generate cost-effectiveness estimates for the screening programme. RESULTS: A total of 35,355 women were screened between 1st November 2003 and 1st March 2013; 136 women (0.38%) were found to be HCV antibody positive. Of 78 (0.22%) viraemic cases, 44 (0.12%) were newly diagnosed. In addition, the screening programme identified three (6.8%) vertical transmissions in children of newly diagnosed mothers. Of 16 newly diagnosed mothers biopsied, all were in the F0-F2 METAVIR disease stages, and 50% had HCV genotype 1. Postnatal treatment with pegylated interferon and ribavirin was initiated in 19 women, with 14 (74%) achieving sustained virologic response. The total cost of screening and confirmation of diagnoses was estimated to be £240,641. This translates to £5469 per newly diagnosed individual. The incremental cost-effectiveness ratio of this screening and treatment strategy was £2400 per QALY gained. Treatment with newer direct-acting antiviral regimens would have a projected cost of £9139 per QALY gained, well below the £20,000-30,000/QALY gained willingness-to-pay threshold applied by policy advisory bodies. CONCLUSIONS: This study demonstrates that an antenatal screening and treatment programme is feasible and effective, at a cost considered acceptable.
Authors: Andrew J Leidner; Harrell W Chesson; Philip R Spradling; Scott D Holmberg Journal: Appl Health Econ Health Policy Date: 2017-02 Impact factor: 2.561
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Authors: José A Boga; Luis Casado; Jonathan Fernández-Suarez; Noelia Moran; Mercedes Rodríguez-Perez; María Martínez-Sela; Ana Pérez; Alicia Garcia-Perez; Candela Menendez; Sagrario Santos; Azucena Rodriguez-Guardado Journal: Am J Trop Med Hyg Date: 2020-04-23 Impact factor: 2.345