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. 2023 Jul:258:113409.
doi: 10.1016/j.jpeds.2023.113409. Epub 2023 Apr 4.

Cost-Effectiveness of Strategies to Identify Children with Perinatally Acquired Hepatitis C Infection

Eric W Hall  1 , Lakshmi Panagiotakopoulos  2 , Carolyn Wester  2 , Noele Nelson  2 , Amy L Sandul  2
Affiliations

Cost-Effectiveness of Strategies to Identify Children with Perinatally Acquired Hepatitis C Infection

Eric W Hall et al. J Pediatr. 2023 Jul.

Abstract

Objective: To determine the optimal testing strategy to identify children with perinatally acquired hepatitis C virus (HCV) infection.

Study design: We used a decision-tree framework with a Markov disease progression model to conduct an economic analysis of 4 strategies, based on combinations of type and timing of test: anti-HCV with reflex to HCV RNA at 18 months among children known to be perinatally exposed (ie, baseline comparison strategy); HCV RNA testing at 2-6 months among infants known to be perinatally exposed (test strategy 1); universal anti-HCV with reflex to HCV RNA at 18 months among all children (test strategy 2); and universal HCV RNA testing at 2-6 months among all infants (test strategy 3). We estimated total cost, quality-adjusted life years, and disease sequalae for each strategy.

Results: Each of the 3 alternative testing strategies resulted in an increased number of children tested and improved health outcomes. HCV RNA testing at 2-6 months (test strategy 1) was cost-saving and resulted in a population-level difference in cost of $469 671. The 2 universal testing strategies resulted in an increase in quality-adjusted life years and an increase in total costs.

Conclusions: Testing of perinatally exposed infants at age 2-6 months with a single HCV RNA test will reduce costs and improve health outcomes, preventing morbidity and mortality associated with complications from perinatal HCV infections.

Keywords: diagnosis; economic evaluation; hepatitis C virus; maternal antibodies.

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Conflict of interest statement

Conflict of Interest Disclosures:

Author EWH reports receiving consulting fees from Merck & Co. for work unrelated to this research. All other authors have no conflicts of interest to report. LP, NN, CW, and ALS report salaries as employees at the US Centers for Disease Control and Prevention.

Figures

None
Sensitivity analysis results: Cost (in 2021 USD) per additional diagnosed infection, by strategy and proportion of pregnant persons screened for HCV, compared with anti-HCV with reflex to HCV RNA testing at 18 months among infants with known exposure, United States, 2022. As a higher proportion of pregnant persons were screened, the cost per additional diagnosed infection increased in the two universal testing scenarios.
Figure 2.
Figure 2.
Decision Tree used in cost-utility analysis of testing approaches for children perinatally exposed to hepatitis C virus, United States, 2022
See this image and copyright information in PMC

References

    1. CDC. Viral hepatitis surveillance—United States, 2020. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2022.
    1. Patrick SW, Dupont WD, McNeer E, McPheeters M, Cooper WO, Aronoff DM, et al. Association of Individual and Community Factors With Hepatitis C Infections Among Pregnant People and Newborns. JAMA Health Forum. 2021;2:e213470–e. - PMC - PubMed
    1. Benova L, Mohamoud YA, Calvert C, Abu-Raddad LJ. Vertical transmission of hepatitis C virus: systematic review and meta-analysis. Clin Infect Dis. 2014;59:765–73. - PMC - PubMed
    1. Tovo PA, Pembrey LJ, Newell ML. Persistence rate and progression of vertically acquired hepatitis C infection. European Paediatric Hepatitis C Virus Infection. J Infect Dis. 2000;181:419–24. - PubMed
    1. Ades AE, Gordon F, Scott K, Collins IJ, Thorne C, Pembrey L, et al. Spontaneous Clearance Of Vertically Acquired Hepatitis C Infection: Implications For Testing And Treatment. Clin Infect Dis. 2022. - PMC - PubMed

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