Elective cesarean delivery to prevent perinatal transmission of hepatitis C virus: a cost-effectiveness analysis.
OBJECTIVE
This study was undertaken to determine whether elective cesarean delivery to avert perinatal hepatitis C virus (HCV) transmission is cost-effective.


METHODS
Using decision analysis, we compared 2 approaches: (1) offering elective cesarean delivery to avert perinatal HCV transmission, (2) performing a cesarean delivery only for obstetric indications. Lifetime cost and quality-adjusted-life-years (QALYs) for HCV-infected neonates were evaluated with Markov analysis. We assumed elective cesarean delivery reduces perinatal HCV transmission, and we varied both the risk reduction caused by elective cesarean delivery and the background risk of perinatal HCV infection.


RESULTS
When elective cesarean section prevents all perinatal HCV transmission, 18 elective cesarean deliveries are necessary to avert 1 neonatal infection with a cost-effectiveness ratio of 34,812 dollars/QALY. At a background perinatal transmission rate of 7.7% elective cesarean deliveries is cost-effective only if it reduces the risk of perinatal transmission by more than 77%.


CONCLUSIONS
Elective cesarean delivery is cost-effective only if it substantially reduces the risk of perinatal HCV transmission.
Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA.
Beth A
BA
Plunkett
William A
WA
Grobman
D002585:Cesarean Section / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D006526:Hepatitis C / Q000191:economics / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data; D011247:Pregnancy