Modelling the potential clinical and economic impact of universal antenatal hepatitis C (HCV) screening and providing treatment for pregnant women with HCV and their infants in Egypt: a cost-effectiveness study
Backgrounds and aims Pregnant women and children are not included in Egypt’s hepatitis C virus (HCV) elimination programmes. This study assesses the cost-effectiveness of several screening and treatment strategies for pregnant women and infants in Egypt.Design A Markov model was developed to simulat...
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| Format: | Article |
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BMJ Publishing Group
2024-04-01
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| Series: | BMJ Public Health |
| Online Access: | https://bmjpublichealth.bmj.com/content/2/1/e000517.full |
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| author | Giuseppe Indolfi Diana M Gibb Aya Mostafa Sarah Pett Yazdan Yazdanpanah Sylvie Deuffic-Burban Anthony E Ades Karen Scott Ali Judd Nadia Hachicha-Maalej Clotilde Lepers Intira Jeannie Collins Manal H El Sayed |
| author_facet | Giuseppe Indolfi Diana M Gibb Aya Mostafa Sarah Pett Yazdan Yazdanpanah Sylvie Deuffic-Burban Anthony E Ades Karen Scott Ali Judd Nadia Hachicha-Maalej Clotilde Lepers Intira Jeannie Collins Manal H El Sayed |
| author_sort | Giuseppe Indolfi |
| collection | DOAJ |
| description | Backgrounds and aims Pregnant women and children are not included in Egypt’s hepatitis C virus (HCV) elimination programmes. This study assesses the cost-effectiveness of several screening and treatment strategies for pregnant women and infants in Egypt.Design A Markov model was developed to simulate the cascade of care and HCV disease progression among pregnant women and their infants according to different screening and treatment strategies, which included: targeted versus universal antenatal screening; treatment of women in pregnancy or deferred till after breast feeding; treatment of infected children at 3 years vs 12 years. Current practice is targeted antenatal screening with deferred treatment for the mother and child. We also explored prophylactic treatment after birth for children of diagnosed HCV-infected women. Discounted lifetime cost, life expectancy (LE) and disability-adjusted life-years (DALYs) were calculated separately for women and their infants, and then combined.Results Current practice led to the highest cost (US$314.0), the lowest LE (46.3348 years) and the highest DALYs (0.0512 years) per mother–child pair. Universal screening and treatment during pregnancy followed by treatment of children at 3 years would be less expensive and more effective (cost saving) compared with current practice (US$219.3, 46.3525 and 0.0359 years). Prophylactic treatment at birth for infants born to HCV RNA-positive mothers would also be similarly cost saving, even with treatment uptake as low as 15% (US$218.6, 46.3525 and 0.0359 years). Findings were robust to reasonable changes in parameters.Conclusion Universal screening and treatment of HCV in pregnancy, with treatment of infected infants at age 3 years is cost saving compared with current practice in the Egyptian setting. |
| format | Article |
| id | doaj-art-c22ef523fb6b4296ab3a8c658092c3e1 |
| institution | Kabale University |
| issn | 2753-4294 |
| language | English |
| publishDate | 2024-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Public Health |
| spelling | doaj-art-c22ef523fb6b4296ab3a8c658092c3e12025-01-29T00:55:09ZengBMJ Publishing GroupBMJ Public Health2753-42942024-04-012110.1136/bmjph-2023-000517Modelling the potential clinical and economic impact of universal antenatal hepatitis C (HCV) screening and providing treatment for pregnant women with HCV and their infants in Egypt: a cost-effectiveness studyGiuseppe Indolfi0Diana M Gibb1Aya Mostafa2Sarah Pett3Yazdan Yazdanpanah4Sylvie Deuffic-Burban5Anthony E Ades6Karen Scott7Ali Judd8Nadia Hachicha-Maalej9Clotilde Lepers10Intira Jeannie Collins11Manal H El Sayed12Paediatric and Liver Unit, Meyer Children`s Hospital IRCCS, Firenze, ItalyMRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK5 Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Faculty of Medicine, Ain Shams University, Cairo, EgyptInstitute for Global Health, University College London, London, UKInserm, IAME, UMR 1137, université Paris Diderot, Hopital Bichat - Claude-Bernard, Paris, Île-de-France, FranceUniversité Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, F-75018 Paris, FrancePopulation Health Sciences, University of Bristol Medical School, Bristol, UKMRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UKMRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UKUniversité Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, F-75018 Paris, FranceUniversité Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, F-75018 Paris, FranceMRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UKDepartment of Pediatrics and the Clinical Research Center, Faculty of Medicine, Ain Shams University, Cairo, EgyptBackgrounds and aims Pregnant women and children are not included in Egypt’s hepatitis C virus (HCV) elimination programmes. This study assesses the cost-effectiveness of several screening and treatment strategies for pregnant women and infants in Egypt.Design A Markov model was developed to simulate the cascade of care and HCV disease progression among pregnant women and their infants according to different screening and treatment strategies, which included: targeted versus universal antenatal screening; treatment of women in pregnancy or deferred till after breast feeding; treatment of infected children at 3 years vs 12 years. Current practice is targeted antenatal screening with deferred treatment for the mother and child. We also explored prophylactic treatment after birth for children of diagnosed HCV-infected women. Discounted lifetime cost, life expectancy (LE) and disability-adjusted life-years (DALYs) were calculated separately for women and their infants, and then combined.Results Current practice led to the highest cost (US$314.0), the lowest LE (46.3348 years) and the highest DALYs (0.0512 years) per mother–child pair. Universal screening and treatment during pregnancy followed by treatment of children at 3 years would be less expensive and more effective (cost saving) compared with current practice (US$219.3, 46.3525 and 0.0359 years). Prophylactic treatment at birth for infants born to HCV RNA-positive mothers would also be similarly cost saving, even with treatment uptake as low as 15% (US$218.6, 46.3525 and 0.0359 years). Findings were robust to reasonable changes in parameters.Conclusion Universal screening and treatment of HCV in pregnancy, with treatment of infected infants at age 3 years is cost saving compared with current practice in the Egyptian setting.https://bmjpublichealth.bmj.com/content/2/1/e000517.full |
| spellingShingle | Giuseppe Indolfi Diana M Gibb Aya Mostafa Sarah Pett Yazdan Yazdanpanah Sylvie Deuffic-Burban Anthony E Ades Karen Scott Ali Judd Nadia Hachicha-Maalej Clotilde Lepers Intira Jeannie Collins Manal H El Sayed Modelling the potential clinical and economic impact of universal antenatal hepatitis C (HCV) screening and providing treatment for pregnant women with HCV and their infants in Egypt: a cost-effectiveness study BMJ Public Health |
| title | Modelling the potential clinical and economic impact of universal antenatal hepatitis C (HCV) screening and providing treatment for pregnant women with HCV and their infants in Egypt: a cost-effectiveness study |
| title_full | Modelling the potential clinical and economic impact of universal antenatal hepatitis C (HCV) screening and providing treatment for pregnant women with HCV and their infants in Egypt: a cost-effectiveness study |
| title_fullStr | Modelling the potential clinical and economic impact of universal antenatal hepatitis C (HCV) screening and providing treatment for pregnant women with HCV and their infants in Egypt: a cost-effectiveness study |
| title_full_unstemmed | Modelling the potential clinical and economic impact of universal antenatal hepatitis C (HCV) screening and providing treatment for pregnant women with HCV and their infants in Egypt: a cost-effectiveness study |
| title_short | Modelling the potential clinical and economic impact of universal antenatal hepatitis C (HCV) screening and providing treatment for pregnant women with HCV and their infants in Egypt: a cost-effectiveness study |
| title_sort | modelling the potential clinical and economic impact of universal antenatal hepatitis c hcv screening and providing treatment for pregnant women with hcv and their infants in egypt a cost effectiveness study |
| url | https://bmjpublichealth.bmj.com/content/2/1/e000517.full |
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