Is adding HCV screening to the antenatal national screening program in Amsterdam, the Netherlands, cost-effective?
BACKGROUND
Hepatitis C virus (HCV) infection can lead to severe liver disease. Pregnant women are already routinely screened for several infectious diseases, but not yet for HCV infection. Here we examine whether adding HCV screening to routine screening is cost-effective.


METHODS
To estimate the cost-effectiveness of implementing HCV screening of all pregnant women and HCV screening of first-generation non-Western pregnant women as compared to no screening, we developed a Markov model. For the parameters of the model, we used prevalence data from pregnant women retrospectively tested for HCV in Amsterdam, the Netherlands, and from literature sources. In addition, we estimated the effect of possible treatment improvement in the future.


RESULTS
The incremental costs per woman screened was €41 and 0.0008 life-years were gained. The incremental cost-effectiveness ratio (ICER) was €52,473 which is above the cost-effectiveness threshold of €50,000. For screening first-generation non-Western migrants, the ICER was €47,113. Best-case analysis for both scenarios showed ICERs of respectively €19,505 and €17,533. We estimated that if costs per treatment were to decline to €3,750 (a reduction in price of €31,000), screening all pregnant women would be cost-effective.


CONCLUSIONS
Currently, adding HCV screening to the already existing screening program for pregnant women is not cost-effective for women in general. However, adding HCV screening for first-generation non-Western women shows a modest cost-effective outcome. Yet, best case analysis shows potentials for an ICER below €20,000 per life-year gained. Treatment options will improve further in the coming years, enhancing cost-effectiveness even more.
Cluster of Infectious Diseases, Public Health Service, Amsterdam, The Netherlands. aurbanus@ggd.amsterdam.nl
Anouk T
AT
Urbanus
Marjolijn
M
van Keep
Amy A
AA
Matser
Mark H
MH
Rozenbaum
Christine J
CJ
Weegink
Anneke
A
van den Hoek
Maria
M
Prins
Maarten J
MJ
Postma
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D016174:Hepacivirus; D006526:Hepatitis C / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D015233:Models, Statistical; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000191:economics*; D055815:Young Adult