Routine hepatitis C virus screening in pregnancy: a cost-effectiveness analysis.
OBJECTIVE
The purpose of this study was to determine whether routine hepatitis C virus screening in pregnancy is cost-effective.


METHODS
A decision tree with Markov analysis was developed to compare 3 approaches to asymptomatic hepatitis C virus infection in low-risk pregnant women: (1) no hepatitis C virus screening, (2) hepatitis C virus screening and subsequent treatment for progressive disease, and (3) hepatitis C virus screening, subsequent treatment for progressive disease, and elective cesarean delivery to avert perinatal transmission. Lifetime costs and quality-adjusted life years were evaluated for mother and child.


RESULTS
In our base case, hepatitis C virus screening and subsequent treatment of progressive disease was dominated (more costly and less effective) by no screening, with an incremental cost of 108 US dollars and a decreased incremental effectiveness of 0.00011 quality-adjusted life years. When compared with no screening, the marginal cost and effectiveness of screening, treatment, and cesarean delivery was 117 US dollars and 0.00010 quality-adjusted life years, respectively, which yields a cost-effectiveness ratio of 1,170,000 US dollars per quality-adjusted life year.


CONCLUSIONS
The screening of asymptomatic pregnant women for hepatitis C virus infection is not cost-effective.
Plunkett
Beth A
BA
Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Grobman
William A
WA
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003955:Diagnostic Tests, Routine / Q000191:economics* / Q000379:methods; D005260:Female; D005865:Gestational Age; D017048:Health Care Costs; D006526:Hepatitis C / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D011181:Postnatal Care / Q000191:economics; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D011295:Prenatal Care / Q000191:economics; D019057:Quality-Adjusted Life Years; D014481:United States