title: Is antenatal screening for hepatitis C virus cost-effective? A decade's experience at a London centre.
abstract: OBJECTIVE
  This study aims to assess the cost-effectiveness of a routine universal antenatal hepatitis C virus (HCV) screening programme at a London centre.
  
  
  METHODS
  Ten years' retrospective antenatal screening and outcome data informed a cost-effectiveness analysis using the previously validated MONARCH model. The cost and quality of life outcomes associated with the screening and treatment of newly identified hepatitis C cases were used to generate cost-effectiveness estimates for the screening programme.
  
  
  RESULTS
  A total of 35,355 women were screened between 1st November 2003 and 1st March 2013; 136 women (0.38%) were found to be HCV antibody positive. Of 78 (0.22%) viraemic cases, 44 (0.12%) were newly diagnosed. In addition, the screening programme identified three (6.8%) vertical transmissions in children of newly diagnosed mothers. Of 16 newly diagnosed mothers biopsied, all were in the F0-F2 METAVIR disease stages, and 50% had HCV genotype 1. Postnatal treatment with pegylated interferon and ribavirin was initiated in 19 women, with 14 (74%) achieving sustained virologic response. The total cost of screening and confirmation of diagnoses was estimated to be £240,641. This translates to £5469 per newly diagnosed individual. The incremental cost-effectiveness ratio of this screening and treatment strategy was £2400 per QALY gained. Treatment with newer direct-acting antiviral regimens would have a projected cost of £9139 per QALY gained, well below the £20,000-30,000/QALY gained willingness-to-pay threshold applied by policy advisory bodies.
  
  
  CONCLUSIONS
  This study demonstrates that an antenatal screening and treatment programme is feasible and effective, at a cost considered acceptable.
authors.affiliation: Department of Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Hepatology, Imperial College, UK. Electronic address: nowlan.selvapatt@imperial.nhs.uk.
authors.forename: Nowlan
authors.initials: N
authors.lastname: Selvapatt
authors.affiliation: Health Economics and Outcomes Research Limited, Wales, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ward
authors.affiliation: University College London Institute of Child Health, London, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Bailey
authors.affiliation: Health Economics and Outcomes Research Limited, Wales, UK.
authors.forename: Hayley
authors.initials: H
authors.lastname: Bennett
authors.affiliation: University College London Institute of Child Health, London, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Thorne
authors.affiliation: Department of Gastroenterology and Hepatology, Kingston Hospital NHS Foundation Trust, UK.
authors.forename: Lay-May
authors.initials: LM
authors.lastname: See
authors.affiliation: Section of Paediatrics, St Mary's Hospital Campus, Imperial College, UK.
authors.forename: Gareth
authors.initials: G
authors.lastname: Tudor-Williams
authors.affiliation: Department of Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Hepatology, Imperial College, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Thursz
authors.affiliation: Health Economics and Outcomes Research Limited, Wales, UK; Swansea Centre for Health Economics, Swansea University, Wales, UK.
authors.forename: Phil
authors.initials: P
authors.lastname: McEwan
authors.affiliation: Department of Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Ashley
authors.initials: A
authors.lastname: Brown
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005240:Feasibility Studies; D005260:Female; D016174:Hepacivirus / Q000235:genetics*; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D015994:Incidence; D008131:London / Q000453:epidemiology; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011296:Prenatal Diagnosis / Q000191:economics*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Antenatal; Cost-effectiveness; Hepatitis C; MONARCH; Pregnancy; Screening