Beth A Plunkett, MD and William A. Grobman, MD, MBA. Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Prentice Women's Hospital, 333 E. Superior St., Chicago, IL 60611, 312-926-7518, p-beth@northwestern.edu

Objective: To determine if screening for hepatitis C virus (HCV) in pregnancy is a cost-effective intervention. Methods: A Markov analytic model was developed to compare 3 strategies: (1) no HCV screening in pregnancy (the current standard of care) (2) HCV screening in pregnancy and subsequent treatment for progressive disease, (3) HCV screening in pregnancy, subsequent treatment for progressive disease and elective cesarean to avert perinatal transmission. Lifetime costs and quality adjusted life years (QALYs) were evaluated for both the mother and her child. One-way sensitivity analyses were performed on all model variables. Results: In our base case, routine HCV screening of asymptomatic pregnant women and treatment of progressive disease yields an average total lifetime cost for mother and child of $4,287.00 and an incremental cost of $99.20 relative to the current policy of no screening. The average effectiveness of screening with appropriate treatment for mother and child is 54.48947 QALYs with a decreased incremental effectiveness of 0.00011 QALY, indicating that no screening dominates screening and treatment. Even if elective cesarean prevents all perinatal transmission, when compared to the current strategy of no screening, the marginal cost and effectiveness of screening with subsequent treatment and cesarean is $106.90 and 0.00010 QALY, respectively, yielding a cost-effectiveness ratio of $1,124,521.69/QALY and is thus not a cost-effective intervention. The model was robust to all cost, utility and probability variables. Conclusion: Screening asymptomatic pregnant women for hepatitis C virus is not a cost-effective intervention.

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