Boston Medical Center, Section of Infectious Diseases, Boston, Massachusetts; the Centers for Disease Control and Prevention, Division of Viral Hepatitis, Atlanta, Georgia; Boston Medical Center, Section of Infectious Diseases, Section of Pediatric Infectious Diseases; and the Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts; and Stanford University, Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford, California.
Obstet Gynecol. 2019 Feb;133(2):289-300. doi: 10.1097/AOG.0000000000003062.
To estimate the clinical effects and cost-effectiveness of universal prenatal hepatitis C screening, and to calculate potential life expectancy, quality of life, and health care costs associated with universal prenatal hepatitis C screening and linkage to treatment.
Using a stochastic individual-level microsimulation model, we simulated the lifetimes of 250 million pregnant women matched at baseline with the U.S. childbearing population on age, injection drug use behaviors, and hepatitis C virus (HCV) infection status. Modeled outcomes included hepatitis C diagnosis, treatment and cure, lifetime health care costs, quality-adjusted life years (QALY) and incremental cost-effectiveness ratios comparing universal prenatal hepatitis C screening to current practice. We modeled whether neonates exposed to maternal HCV at birth were identified as such.
Pregnant women with hepatitis C infection lived 1.21 years longer and had 16% lower HCV-attributable mortality with universal prenatal hepatitis C screening, which had an incremental cost-effectiveness ratio of $41,000 per QALY gained compared with current practice. Incremental cost-effectiveness ratios remained below $100,000 per QALY gained in most sensitivity analyses; notable exceptions included incremental cost-effectiveness ratios above $100,000 when assuming mean time to cirrhosis of 70 years, a cost greater than $500,000 per false positive diagnosis, or population HCV infection prevalence below 0.16%. Universal prenatal hepatitis C screening increased identification of neonates exposed to HCV at birth from 44% to 92%.
In our model, universal prenatal hepatitis C screening improves health outcomes in women with HCV infection, improves identification of HCV exposure in neonates born at risk, and is cost-effective.
评估普遍产前丙型肝炎筛查的临床效果和成本效益，并计算普遍产前丙型肝炎筛查及与治疗相关的联系对潜在预期寿命、生活质量和医疗保健成本的影响。
使用随机个体水平微观模拟模型，我们对 2.5 亿名孕妇的一生进行了模拟，这些孕妇在基线时按年龄、注射毒品行为和丙型肝炎病毒（HCV）感染状况与美国生育人口相匹配。模型结果包括丙型肝炎的诊断、治疗和治愈、终身医疗保健成本、质量调整生命年（QALY）和增量成本效益比，以比较普遍产前丙型肝炎筛查与当前实践。我们还对是否对出生时暴露于母体 HCV 的新生儿进行了识别进行了建模。
感染 HCV 的孕妇的寿命延长了 1.21 年，与当前实践相比，HCV 归因死亡率降低了 16%，具有增量成本效益比为 41,000 美元/QALY。在大多数敏感性分析中，增量成本效益比仍低于 100,000 美元/QALY；值得注意的例外包括假设肝硬化的平均时间为 70 年、假阳性诊断的费用超过 500,000 美元或人群 HCV 感染率低于 0.16%时，增量成本效益比超过 100,000 美元/QALY。普遍产前丙型肝炎筛查使暴露于 HCV 的新生儿的识别率从 44%提高到 92%。
在我们的模型中，普遍产前丙型肝炎筛查改善了 HCV 感染妇女的健康结果，提高了对有风险的新生儿 HCV 暴露的识别，并具有成本效益。
