Routine screening for hepatitis C in pregnancy is cost-effective in a large urban population in Ireland: a retrospective study

Objective 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. Design Retrospective study and model-based economic evaluation. Setting Two urban tertiary referral maternity units, currently using risk factor-based screening for HCV infection. Population Pregnant women who had been tested for hepatitis B, HIV but not HCV. Methods 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. Main outcome measures Presence of HCV antigen and cost per quality-adjusted life year (QALY). Results 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 euro3,315 per QALY gained. Conclusion 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. Tweetable abstract Universal maternal screening for hepatitis C is cost-effective in this urban Irish population.