The cost-effectiveness of elective Cesarean delivery to prevent hepatitis C transmission in HIV-coinfected women.
OBJECTIVE
To determine the net health consequences, costs, and cost-effectiveness of elective Cesarean delivery (C-section) to prevent perinatal transmission of hepatitis C virus (HCV) in HIV/HCV-coinfected women with suppressed HIV RNA but detectable HCV RNA.


METHODS
Cost-effectiveness analysis using a probabilistic decision model.


METHODS
The model compared two strategies: (i) C-section for all coinfected women with suppressed HIV RNA but detectable HCV RNA; (ii) C-section only when indicated based on fetal status. Outcomes included vertical transmission of HCV, maternal mortality, quality-adjusted life expectancy, delivery and HCV treatment costs, and incremental cost-effectiveness ratios. Data were obtained from the literature and national databases. Delivery cost data were from a hospital consortium database. Probability distributions were derived from published confidence intervals or estimated ranges, or calculated using reported sample sizes.


RESULTS
Elective C-section in coinfected women with suppressed HIV RNA but detectable HCV RNA would avoid 45 vertical HCV transmissions per 1000 deliveries and increase maternal mortality by one death per 100 000 deliveries. The incremental cost-effectiveness ratio of a recommendation for C-section versus current practice was 3900-6100 dollars per quality-adjusted life year for the mother-child pair. Results are sensitive to the efficacy of C-section in preventing transmission, the probability of vaginal delivery without a recommendation, and rates of maternal acceptance of the recommendation.


CONCLUSIONS
Assuming 2000 births/year among HIV/HCV-coinfected women in the United States, a recommendation for elective C-section in these women could avoid an additional 90 perinatal HCV transmissions per year with a risk of one maternal death in 50 years.
Divisions of Outcomes and Effectiveness, Department of Public Health, Weill Medical College of Cornell University, New York, NY 10021, USA. brs2006@med.cornell.edu
Bruce R
BR
Schackman
Kawai
K
Oneda
Sue J
SJ
Goldie
D002585:Cesarean Section / Q000191:economics*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006526:Hepatitis C / Q000150:complications / Q000517:prevention & control*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity