BACKGROUND Hepatitis C virus' (HCV) chronic prevalence among pregnant women in the United States doubled nationally from 2009-2014 (~0.7%), yet many cases remain undiagnosed. Screening pregnant women is not recommended by the Society of Maternal-Fetal Medicine or the Centers for Disease Control and Prevention, despite new American Association For the Study of Liver Diseases (AASLD)/Infectious Diseases Society of America (IDSA) guidelines recommending screening for this group. We assessed the cost-effectiveness of HCV screening for pregnant women in the United States. METHODS An HCV natural history Markov model was used to evaluate the cost-effectiveness of universal HCV screening of pregnant women, followed by treatment after pregnancy, compared to background risk-based screening from a health-care payer perspective. We assumed a HCV chronic prevalence of 0.73% among pregnant women, based on national data. We assumed no Medicaid reimbursement restrictions by fibrosis stage at baseline, but explored differing restrictions in sensitivity analyses. We assessed costs (in US dollars) and health outcomes (in quality-adjusted life-years [QALYs]) over a lifetime horizon, using new HCV drug costs of $25 000/treatment. We assessed mean incremental cost-effectiveness ratios (ICERs) under a willingness-to-pay threshold of $50 000/QALY gained. We additionally evaluated the potential population impact. RESULTS Universal antenatal screening was cost-effective in all treatment eligibility scenarios (mean ICER <$3000/QALY gained). Screening remained cost-effective at a prevalence of 0.07%, which is the lowest estimated prevalence in the United States (in Hawaii). Screening the ~5.04 million pregnant women in 2018 could result in the detection and treatment of 33 000 women, based on current fibrosis restrictions. CONCLUSIONS Universal screening for HCV among pregnant women in the United States is cost-effective and should be recommended nationally.

中文翻译：

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美国孕妇普遍丙型肝炎病毒筛查的成本效益。


背景 2009 年至 2014 年间，美国孕妇丙型肝炎病毒 (HCV) 慢性患病率在全国范围内翻了一番（约 0.7%），但许多病例仍未确诊。尽管美国肝病研究协会 (AASLD)/美国传染病学会 (IDSA) 新指南建议对孕妇进行筛查，但母胎医学协会或疾病控制与预防中心并不建议对孕妇进行筛查团体。我们评估了美国孕妇 HCV 筛查的成本效益。方法 使用 HCV 自然史马尔可夫模型来评估对孕妇进行普遍 HCV 筛查以及妊娠后治疗的成本效益，并与从医疗保健支付者角度进行的基于背景风险的筛查进行比较。根据国家数据，我们假设孕妇中 HCV 慢性患病率为 0.73%。我们假设基线时纤维化阶段没有医疗补助报销限制，但在敏感性分析中探讨了不同的限制。我们评估了一生中的成本（以美元为单位）和健康结果（以质量调整生命年 [QALY] 为单位），使用的新 HCV 药物成本为 25 000 美元/次治疗。我们评估了在 50 000 美元/QALY 支付意愿门槛下的平均增量成本效益比 (ICER)。我们还评估了潜在的人口影响。结果 普遍产前筛查在所有治疗资格情况下都具有成本效益（平均 ICER<$3000/QALY 增加）。筛查仍具有成本效益，患病率为 0.07%，这是美国（夏威夷）估计患病率最低的水平。筛选〜5。根据目前的纤维化限制，2018 年有 400 万孕妇可能会发现并治疗 33,000 名妇女。结论 在美国孕妇中普遍筛查 HCV 具有成本效益，应在全国范围内推荐。