PIN55 Cost-Effectiveness of Hepatitis C VIRUS Screening, and Subsequent Monitoring or Treatment Among Pregnant Women in the Netherlands

Abstract

The prevalence of diagnosed chronic hepatitis C virus (HCV) infection among pregnant women in the Netherlands is 0.26%, yet many cases remain undiagnosed. HCV screening and treatment of pregnant HCV carriers could reduce the burden of disease and limit vertical transmission from mother to child. This study aims to assess the impact of HCV screening and subsequent treatment with new direct-acting antivirals among pregnant women in the Netherlands. An HCV natural history Markov transition state model was developed, to evaluate the cost-effectiveness of HCV screening and treatment. Besides all 179,000 pregnant women in the Netherlands (cohort 1), we modelled three further cohorts: all 79,000 first-time pregnant women (cohort 2), 33,000 pregnant migrant women (cohort 3) and 16,000 first-time pregnant migrant women (cohort 4). Each cohort was analyzed in various scenarios: (i) no intervention, i.e. the current practice, (ii) screen-and-treat, i.e. the most extensive approach involving treatment of all individuals found HCV-positive, and (iii) screen-and-treat/monitor, i.e. a strategy involving treatment of symptomatic patients and follow-up of asymptomatic HCV carriers with subsequent treatment only at progression. For all studied cohorts, comparison between scenarios (ii) and (i) resulted in ICERs varying between €8,343 and €9,182 per QALY gained, with a budget impact varying from €11,283,830 to €34,502,880. For all cohorts, comparison between scenarios (iii) and (i) resulted in ICERs between €1,566 and €2,518 per QALY gained with budget impact varying from €1,668,670 to €6,534,650. For all cohorts, the ICERs involved in potentially unnecessary treatment of asymptomatic HCV carriers varied between €52,432 and €53,641, well above the willingness-to-pay (WTP) threshold of €20,000 per QALY gained. Screening for HCV among all pregnant women in the Netherlands is cost-effective. However, for active screening and treatment, it would be most reasonable to consider smaller risk groups in view of the budget impact.