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Cost-Effectiveness of One-Time Universal Childhood Hepatitis C Screening in the United States
Jessica Frankeberger1,2, Melissa Choz2, Tatyana Kushner3,4
1Department of Pediatrics, University of California, San Diego, CA, United States.
Insights
Universal Hepatitis C Virus (HCV) screening in children at ages 2 and 10 is cost-effective. This approach identifies more cases than risk-based screening, improving health outcomes and potentially lowering long-term healthcare costs.
Area of Science:
- Pediatric infectious diseases
- Public health policy
- Health economics
Background:
- Hepatitis C Virus (HCV) infection during pregnancy is rising, increasing the number of infants exposed perinatally.
- Current pediatric screening relies on risk-based methods, leading to undiagnosed cases.
- Universal screening in pregnancy is recommended, but follow-up for children is inconsistent.
Purpose of the Study:
- To evaluate the cost-effectiveness of universal Hepatitis C Virus (HCV) screening for children at ages 2 and 10.
- To compare universal screening against the current standard of risk-based screening for children with prenatal HCV exposure.
Main Methods:
- A Markov model simulated HCV natural history and evaluated cost-effectiveness.
- Assessed universal screening at ages 2 and 10 independently versus risk-based screening.
- Calculated incremental cost-effectiveness ratios (ICERs) against a $50,000/QALY willingness-to-pay threshold.
Main Results:
- Universal HCV screening at age 2 was cost-effective (ICER=$8,774/QALY gained).
- Universal HCV screening at age 10 was also cost-effective (ICER=$4,404/QALY gained).
- Sensitivity analyses confirmed the robustness of these findings across various prevalence and screening rates.
Conclusions:
- Universal childhood screening for Hepatitis C Virus (HCV) is a cost-effective strategy.
- National guidelines should consider implementing universal screening, especially when integrated with routine pediatric blood tests.
- Early detection through universal screening can improve long-term health outcomes for children exposed to HCV.
Background:
Hepatitis C Virus (HCV) in pregnancy has increased, leading to increased perinatally exposed infants. Although universal HCV screening in pregnancy is recommended, pediatric cases remain undiagnosed. We examine the cost-effectiveness of universal HCV screening among children at age 2 and 10, when other routine blood testing is recommended.
Methods:
An HCV natural history Markov model evaluated the cost-effectiveness of universal HCV screening independently at ages 2 and 10 compared to the currently recommended risk-based screening of children born to those with HCV. Based on previous literature, we assumed a 0.05% pediatric HCV chronic prevalence (0.73% chronic prevalence among pregnant persons and 7.2% vertical transmission). In the status-quo scenario, we assumed 23% of children with prenatal HCV exposure were screened. We assessed costs (United States Dollar), quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER, $ per QALY gained) compared to a willingness-to-pay threshold (WTP) of $50 000/QALY. We explored parameter uncertainty, including pediatric HCV chronic prevalence and screening rates, in multiple sensitivity analyses.
Results:
Universal HCV screening at age 2 was cost-effective (ICER = $8774/QALY gained) compared to the status-quo risk-based screening. The lowest pediatric HCV chronic prevalence in which universal screening remained cost-effective under a WTP of $50 000/QALY was 0.007%. At age 10, universal screening was cost-effective compared to risk-based screening (ICER = $4404/gained) and was cost-effective at the lowest HCV prevalence in children of 0.006%. Models at both age 2 and 10 were robust to sensitivity analyses.
Conclusions:
Universal HCV screening in childhood is cost-effective. Guidelines should consider recommending universal screening nationally, particularly if it can be conducted along with other routine pediatric blood draws.
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