National Maternity Hospital, Dublin, Ireland.
St Vincent's University Hospital, Dublin, Ireland.
BJOG. 2022 Jan;129(2):322-327. doi: 10.1111/1471-0528.16984. Epub 2021 Nov 20.
To investigate whether risk factor-based screening in pregnancy is failing to identify women with hepatitis C virus (HCV) infection and to assess the cost-effectiveness of universal screening.
Retrospective study and model-based economic evaluation.
Two urban tertiary referral maternity units, currently using risk factor-based screening for HCV infection.
Pregnant women who had been tested for hepatitis B, HIV but not HCV.
Anonymised sera were tested for HCV antibody. Positive sera were tested for HCV antigen. A cost-effectiveness analysis of a change to universal screening was performed using a Markov model to simulate disease progression and Monte Carlo simulations for probabilistic sensitivity analysis.
Presence of HCV antigen and cost per quality-adjusted life year (QALY).
In all, 4655 samples were analysed. Twenty had HCV antibodies and five HCV antigen. This gives an active infection rate of 5/4655, or 0.11%, compared with a rate of 0.15% in the risk-factor group. This prevalence is 65% lower than a previous study in the same hospitals from 2001 to 2005. The calculated incremental cost-effectiveness ratio (ICER) for universal screening was €3,315 per QALY gained.
This study showed that the prevalence of HCV infection in pregnant women in the Dublin region has declined by 65% over the past two decades. Risk factor-based screening misses a significant proportion of infections. A change to universal maternal screening for hepatitis C would be cost-effective in our population.
Universal maternal screening for hepatitis C is cost-effective in this urban Irish population.
调查妊娠时基于危险因素的筛查是否未能识别丙型肝炎病毒（HCV）感染的妇女，并评估普遍筛查的成本效益。
回顾性研究和基于模型的经济评估。
目前使用基于危险因素的 HCV 感染筛查的两个城市三级转诊产科单位。
接受过乙型肝炎、HIV 检测但未接受 HCV 检测的孕妇。
对 HCV 抗体进行匿名血清检测。对 HCV 抗原呈阳性的血清进行检测。使用 Markov 模型模拟疾病进展，并进行蒙特卡罗模拟进行概率敏感性分析，对普遍筛查的改变进行成本效益分析。
HCV 抗原的存在和每质量调整生命年（QALY）的成本。
共分析了 4655 个样本。20 个有 HCV 抗体，5 个有 HCV 抗原。这使得活跃感染率为 5/4655，即 0.11%，而危险因素组的感染率为 0.15%。与 2001 年至 2005 年同一医院的先前研究相比，这一流行率降低了 65%。普遍筛查的增量成本效益比（ICER）为每获得一个 QALY 增加 3315 欧元。
本研究表明，过去二十年来，都柏林地区孕妇丙型肝炎感染的流行率下降了 65%。基于危险因素的筛查会遗漏很大一部分感染。在我们的人群中，改变对丙型肝炎的普遍产妇筛查将具有成本效益。
在这个城市爱尔兰人群中，普遍的产妇丙型肝炎筛查具有成本效益。
