Routine hepatitis C virus screening in pregnancy: A cost-effectiveness analysis

Objective The purpose of this study was to determine whether routine hepatitis C virus screening in pregnancy is cost-effective. Study design A decision tree with Markov analysis was developed to compare 3 approaches to asymptomatic hepatitis C virus infection in low-risk pregnant women: (1) no hepatitis C virus screening, (2) hepatitis C virus screening and subsequent treatment for progressive disease, and (3) hepatitis C virus screening, subsequent treatment for progressive disease, and elective cesarean delivery to avert perinatal transmission. Lifetime costs and quality-adjusted life years were evaluated for mother and child. Results In our base case, hepatitis C virus screening and subsequent treatment of progressive disease was dominated (more costly and less effective) by no screening, with an incremental cost of $108 and a decreased incremental effectiveness of 0.00011 quality-adjusted life years. When compared with no screening, the marginal cost and effectiveness of screening, treatment, and cesarean delivery was $117 and 0.00010 quality-adjusted life years, respectively, which yields a cost-effectiveness ratio of $1,170,000 per quality-adjusted life year. Conclusion The screening of asymptomatic pregnant women for hepatitis C virus infection is not cost-effective.