Universal HCV Screening of Pregnant Women Is Cost-Effective, Should Be Adopted Nationally, Study Urges

Universal hepatitis C virus (HCV) screening among pregnant women in the United States is cost effective and improves detection of HCV among women and children, according to a study published in Clinical Infectious Diseases. The authors call on national professional societies to endorse universal testing.

HCV infection rates among pregnant women have doubled nationally between 2009 and 2014 to about 0.7 percent (or roughly 42,000 pregnancies annually), but infection rates reach as high as 8 percent in rural Tennessee. These increases are largely associated with increases in opioid injection.

Risk-based screening of pregnant women is recommended by the Society of Maternal-Fetal Medicine (SMFM), the American College of Obstetrics and Gynecology (ACOG), and the U.S. Centers for Disease Control and Prevention (CDC), while the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America has joint guidelines recommending universal screening. As of now, Kentucky is the only state to pass HCV testing regulations requiring all pregnant women to be tested during their first prenatal visit with a health provider.

The researchers developed a model to evaluate from a payer perspective the cost-effectiveness of universal HCV screening of pregnant women followed by treatment after pregnancy versus risk-based screening. Baseline assumptions, based on national data, included: 0.73 percent HCV chronic prevalence among pregnant women, no Medicaid reimbursement restrictions for treatment by fibrosis stage at baseline, new HCV drug costs of $25,000/treatment, and a willingness to pay threshold of $50,000 per quality-adjusted life year (QALY) gained.

The model showed that universal HCV screening for pregnant woman was associated with incremental costs of $53.20. Universal screening was cost-effective in all treatment eligibility scenarios, with mean incremental cost-effectiveness ratios of less than $3,000 per QALY gained). Screening remained cost-effective at 0.07 percent prevalence, the lowest estimated prevalence of any U.S. state (Hawaii). Screening the estimated 5.04 million pregnant women in 2018 could result in detection and treatment of 33,000 women based on current fibrosis restrictions.

"Our results support calls for a change of SMFM/ACOG and CDC guidelines to recommend universal HCV screening of pregnant women," write the authors led by Antoine Chaillon, from University of California San Diego. "Our results also provide additional economic evidence in support of the updated AASLD/IDSA guidelines and Kentucky legislation recommending screening pregnant women."

Takeaway: Given the rise of HCV infection as a result of the opioid epidemic, there is growing momentum to increase HCV screening among U.S. pregnant women.