Universal screening for HCV superior to risk-based approach in pregnant women

Issue: November/December 2018

SAN FRANCISCO — Universal screening of pregnant women at risk for hepatitis C was more efficient and cost-effective compared with risk-based screening, according to data presented at The Liver Meeting 2018.

“Our study was prompted by this combination of what was happening with the opioid epidemic and the very high number of young women testing positive for hepatitis C,” Michelle Rose, MBA, population health manager from Norton Healthcare in Kentucky, said during a press conference presentation. “The numbers reached a point that ... it was operationally and medically more sensical to universally screen.”

Rose and colleagues conducted a retrospective analysis of testing practices during a risk-based screening period between May 2014 and December 2015. They compared these results with prospective data gathered during a universal screening period between May 2016 and December 2017.

The researchers found 17.9% of 10,420 pregnant women seen during the risk-based period received screening. During the universal screening period, 9,033 pregnant women received screening.

Results showed that universal screening did not increase the likelihood of an antibody test. However, universal screening significantly correlated with an increased likelihood of receiving a confirmatory RNA test (OR = 1.8; 95% CI, 1.5-2.3) and confirmation of active infection (OR = 2.1; 95% CI, 1.4-3).

Universal screening increased the cost per patient by $308 with an incremental cost-effectiveness ratio of $18,139 per active infection identified or $4,662 per quality-adjusted life year gained.

Additionally, Rose noted that the rate of antibody seropositivity increased from 4.3% in the risk-based period to 4.9% in the universal screening period.

“This is not exactly what you’d expect to find when it comes to universal screening, you might expect a drop in prevalence when combining the general population and those at risk,” Rose said.

Jordan Feld, MD, MPH, from the Toronto General Hospital Research Institute and moderator of the press conference, echoed Rose’s thoughts and noted that an increase in prevalence after implementing universal screening was extremely surprising and highlighted a need to look further into correlated risks between pregnancy and hepatitis C infection.

“I’m often asked why you would screen pregnant women for hepatitis C, because you can’t treat them, but what we find is that we have a lot of infection and there’s no way to understand what’s happening with the child if you don’t understand what’s happening with the mother,” Rose said. “Testing during pregnancy is an opportunity to set up a register in which we can follow the mother and child and link the mother to care and follow the child for future screening.” – by Talitha Bennett

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Reference:

Rose M, et al. Abstract 0087. Presented at: The Liver Meeting 2018; Nov. 9-13, 2018; San Francisco.

Disclosure: Rose reports she has received grant or research support from Gilead Sciences.