Abstract
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.