Hachicha-Maalej Nadia, Lepers Clotilde, Collins Intira Jeannie, Mostafa Aya, Ades Anthony E, Judd Ali, Scott Karen, Gibb Diana M, Pett Sarah, Indolfi Giuseppe, Yazdanpanah Yazdan, El Sayed Manal H, Deuffic-Burban Sylvie
Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, F-75018 Paris, France.
MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK.
BMJ Public Health. 2024 Mar 29;2(1):e000517. doi: 10.1136/bmjph-2023-000517. eCollection 2024 Jun.
Pregnant women and children are not included in Egypt's hepatitis C virus (HCV) elimination programmes. This study assesses the cost-effectiveness of several screening and treatment strategies for pregnant women and infants in Egypt.
A Markov model was developed to simulate the cascade of care and HCV disease progression among pregnant women and their infants according to different screening and treatment strategies, which included: targeted versus universal antenatal screening; treatment of women in pregnancy or deferred till after breast feeding; treatment of infected children at 3 years vs 12 years. Current practice is targeted antenatal screening with deferred treatment for the mother and child. We also explored prophylactic treatment after birth for children of diagnosed HCV-infected women. Discounted lifetime cost, life expectancy (LE) and disability-adjusted life-years (DALYs) were calculated separately for women and their infants, and then combined.
Current practice led to the highest cost (US$314.0), the lowest LE (46.3348 years) and the highest DALYs (0.0512 years) per mother-child pair. Universal screening and treatment during pregnancy followed by treatment of children at 3 years would be less expensive and more effective (cost saving) compared with current practice (US$219.3, 46.3525 and 0.0359 years). Prophylactic treatment at birth for infants born to HCV RNA-positive mothers would also be similarly cost saving, even with treatment uptake as low as 15% (US$218.6, 46.3525 and 0.0359 years). Findings were robust to reasonable changes in parameters.
Universal screening and treatment of HCV in pregnancy, with treatment of infected infants at age 3 years is cost saving compared with current practice in the Egyptian setting.
埃及的丙型肝炎病毒（HCV）消除计划未将孕妇和儿童纳入其中。本研究评估了埃及针对孕妇和婴儿的几种筛查与治疗策略的成本效益。
构建了一个马尔可夫模型，以根据不同的筛查与治疗策略模拟孕妇及其婴儿的护理流程和HCV疾病进展，这些策略包括：针对性产前筛查与普遍产前筛查；孕期治疗女性还是推迟至母乳喂养后治疗；3岁与12岁时治疗受感染儿童。当前的做法是进行针对性产前筛查，推迟对母婴的治疗。我们还探讨了对诊断为HCV感染女性的子女出生后进行预防性治疗。分别计算了女性及其婴儿的贴现终身成本、预期寿命（LE）和伤残调整生命年（DALYs），然后进行合并。
按照当前做法，每对母婴的成本最高（314.0美元），预期寿命最低（46.3348岁），伤残调整生命年最高（0.0512年）。与当前做法相比，孕期进行普遍筛查和治疗，随后在3岁时治疗儿童，成本更低且更有效（节省成本）（219.3美元、46.3525岁和0.0359年）。即使治疗接受率低至15%，对HCV RNA阳性母亲所生婴儿出生时进行预防性治疗同样能节省成本（218.6美元、46.3525岁和0.0359年）。研究结果在参数合理变化时具有稳健性。
在埃及的情况下，孕期对HCV进行普遍筛查和治疗，并在感染婴儿3岁时进行治疗，与当前做法相比可节省成本。
