Related Experiment Video
Updated: Aug 4, 2025
Development of a Hepatitis B Virus Reporter System to Monitor the Early Stages of the Replication Cycle
Published on: February 1, 2017
Cost-Effectiveness of Strategies to Identify Children with Perinatally Acquired Hepatitis C Infection
Eric W Hall1, Lakshmi Panagiotakopoulos2, Carolyn Wester2
1OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR.
Insights
Early hepatitis C virus (HCV) RNA testing for infants at 2-6 months is cost-saving. This strategy improves health outcomes and prevents complications from perinatal HCV infection.
Area of Science:
- Pediatric infectious diseases
- Public health policy
- Health economics
Background:
- Perinatal hepatitis C virus (HCV) infection poses risks to children.
- Optimal strategies for identifying and managing these infections are crucial.
Purpose of the Study:
- To determine the most effective and economical testing strategy for identifying perinatally acquired HCV infection in children.
- To compare four distinct testing approaches based on test type and timing.
Main Methods:
- A decision-tree framework and Markov disease progression model were employed for economic analysis.
- Evaluated strategies included anti-HCV with reflex HCV RNA at 18 months, HCV RNA at 2-6 months, universal anti-HCV with reflex, and universal HCV RNA testing.
Main Results:
- All three alternative strategies increased testing and improved health outcomes compared to the baseline.
- HCV RNA testing at 2-6 months (test strategy 1) was cost-saving, with a population-level cost difference of $469,671.
- Universal testing strategies increased quality-adjusted life years but also increased overall costs.
Conclusions:
- Testing perinatally exposed infants at 2-6 months with a single HCV RNA test is the optimal strategy.
- This approach reduces costs, improves health outcomes, and prevents morbidity and mortality from perinatal HCV infections.
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.
