About 4 million people in the United States are infected with hepatitis C virus (HCV), including an estimated 1 to 4 percent of pregnant women. Nevertheless, it is not cost effective to screen asymptomatic low-risk pregnant women for HCV, according to a study supported in part by the Agency for Healthcare Research and Quality (T32 HS00078). This finding agrees with current recommendations.
Beth A. Plunkett, M.D., M.P.H., and William A. Grobman, M.D., M.B.A., of Northwestern University Feinberg School of Medicine, used decision analysis to assess the cost-effectiveness of HCV screening of asymptomatic pregnant women. They compared three approaches to HCV screening: no HCV screening; HCV screening and subsequent treatment for progressive disease; and HCV screening, subsequent treatment for progressive disease, and elective cesarean delivery to avert perinatal transmission of the virus.
In simulation trials of 10,000 women, 18 percent of the women in the unscreened population experienced liver cirrhosis over a 15-year period and 23 percent over a 30-year period; 3 and 4 percent suffered from liver cancer over 15 and 30 years, respectively. HCV screening and subsequent treatment of progressive disease was more costly and less effective than no screening. It resulted in an average total lifetime cost for mother and child of $4,552 and an incremental cost of $108 relative to the current policy of no screening, for a cost-effectiveness ratio of $1,170,000 per quality-adjusted life year (QALY). Compared with no screening, the marginal cost and effectiveness of screening, treatment, and cesarean delivery was $117 with a cost-effectiveness ratio of $1,170,000 per QALY. Medical interventions are typically considered cost effective at $50,000 or less per QALY.
See "Routine hepatitis C virus screening in pregnancy: A cost-effectiveness analysis," by Drs. Plunkett and Grobman, in the April 1, 2005, American Journal of Obstetrics and Gynecology 192, pp. 1153-1161.