美国孕妇普遍进行丙型肝炎病毒筛查的成本效益
Cost-effectiveness of Universal Hepatitis C Virus Screening of Pregnant Women in the United States.
作者信息
Chaillon Antoine, Rand Elizabeth B, Reau Nancy, Martin Natasha K
机构信息
Division of Infectious Diseases and Global Public Health, University of California San Diego.
Perelman School of Medicine, University of Pennsylvania, Philadelphia.
出版信息
Clin Infect Dis. 2019 Nov 13;69(11):1888-1895. doi: 10.1093/cid/ciz063.
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.
背景
2009年至2014年期间，美国孕妇中丙型肝炎病毒（HCV）的慢性感染率在全国范围内翻了一番（约0.7%），但仍有许多病例未被诊断出来。尽管美国肝病研究协会（AASLD）/美国传染病学会（IDSA）发布了新指南，建议对这一群体进行筛查，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。我们评估了美国对孕妇进行HCV筛查的成本效益。
方法
从医疗保健支付方的角度，使用HCV自然史马尔可夫模型来评估对孕妇进行普遍HCV筛查并在产后进行治疗，与基于背景风险的筛查相比的成本效益。根据全国数据，我们假设孕妇中HCV慢性感染率为0.73%。我们假设基线时按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。我们使用每疗程25000美元的新型HCV药物成本，评估了一生期间的成本（以美元计）和健康结果（以质量调整生命年[QALY]计）。我们在每获得一个QALY支付意愿阈值为50000美元的情况下评估平均增量成本效益比（ICER）。我们还评估了潜在的人群影响。
结果
在所有治疗资格情况下，普遍产前筛查都具有成本效益（平均ICER <每获得一个QALY 3000美元）。在患病率为0.07%时筛查仍具有成本效益，这是美国（夏威夷）估计的最低患病率。根据目前的纤维化限制，对2018年约504万孕妇进行筛查可能会检测并治疗33000名妇女。
结论
在美国对孕妇进行普遍的HCV筛查具有成本效益，应在全国范围内予以推荐。
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