Is antenatal screening for hepatitis C virus cost-effective? A decade's experience at a London centre

J Hepatol. 2015 Oct;63(4):797-804. doi: 10.1016/j.jhep.2015.05.015. Epub 2015 May 27.


Background & aims: This study aims to assess the cost-effectiveness of a routine universal antenatal hepatitis C virus (HCV) screening programme at a London centre.

Methods: Ten years' retrospective antenatal screening and outcome data informed a cost-effectiveness analysis using the previously validated MONARCH model. The cost and quality of life outcomes associated with the screening and treatment of newly identified hepatitis C cases were used to generate cost-effectiveness estimates for the screening programme.

Results: A total of 35,355 women were screened between 1st November 2003 and 1st March 2013; 136 women (0.38%) were found to be HCV antibody positive. Of 78 (0.22%) viraemic cases, 44 (0.12%) were newly diagnosed. In addition, the screening programme identified three (6.8%) vertical transmissions in children of newly diagnosed mothers. Of 16 newly diagnosed mothers biopsied, all were in the F0-F2 METAVIR disease stages, and 50% had HCV genotype 1. Postnatal treatment with pegylated interferon and ribavirin was initiated in 19 women, with 14 (74%) achieving sustained virologic response. The total cost of screening and confirmation of diagnoses was estimated to be £240,641. This translates to £5469 per newly diagnosed individual. The incremental cost-effectiveness ratio of this screening and treatment strategy was £2400 per QALY gained. Treatment with newer direct-acting antiviral regimens would have a projected cost of £9139 per QALY gained, well below the £20,000-30,000/QALY gained willingness-to-pay threshold applied by policy advisory bodies.

Conclusions: This study demonstrates that an antenatal screening and treatment programme is feasible and effective, at a cost considered acceptable.

Keywords: Antenatal; Cost-effectiveness; Hepatitis C; MONARCH; Pregnancy; Screening.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cost-Benefit Analysis
  • Feasibility Studies
  • Female
  • Hepacivirus / genetics*
  • Hepatitis C / diagnosis
  • Hepatitis C / epidemiology*
  • Hepatitis C / virology
  • Humans
  • Incidence
  • London / epidemiology
  • Middle Aged
  • Pregnancy
  • Pregnancy Complications, Infectious*
  • Prenatal Diagnosis / economics*
  • Retrospective Studies
  • Young Adult