Routine screening for Hepatitis C in pregnancy is cost effective in a large urban population in Ireland: a retrospective study

Chronic hepatitis C (CHC) is a major health problem worldwide, with approximately 200 million affected individuals and a significant rate of progression to end-stage cirrhosis and hepatocellular carcinoma (HCC). If hepatitis C virus (HCV) infection is left untreated in the population, then the number of liver-related deaths will soon double and the need for liver transplantation may increase to five times that seen today. Available therapies for CHC are restricted to interferon alpha (IFN-α ) monotherapy and to the combination of IFN-α and ribavirin. Despite their high cost and side effects, both of these therapies have proved to be cost effective, particularly combination therapy. IFN-α monotherapy for one year can induce sustained response (SR) rates of approximately 10% in naive patients infected with HCV genotype 1, and above 50% in those infected with other genotypes. Combination therapy can double or even triple the rate of SR in genotype 1 infections and may further increase the SR rate in the other HCV genotypes. Combination therapy has also been proven to be effective in approximately 50% of relapsed responders to IFN-α monotherapy. In clinical practice, the decision to treat should be individualized and tailored on the basis of several virus- and host-related factors, particularly the grade and stage of liver disease, HCV genotype and levels of viremia. Appropriate monitoring of therapy by careful clinical evaluation, liver biochemistry and serumHCVRNAtesting is mandatory. IFN-α therapy may also prove to be effective in reducing the rate of HCC development in CHC regardless of whether a virological response is achieved, but this remains to be established.

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Should routine screening for vitamin D deficiency be performed in pregnancy?

Evidence-Based Practice ◽

10.1097/01.ebp.0000541554.51041.73 ◽

2016 ◽

Vol 19 (11) ◽

pp. 8

Author(s):

Charmaine Silveira Da Graca Costa ◽

Kathryn Hoffmann

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Routine Screening ◽

In Pregnancy

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A retrospective study of the health profile of neonates of mothers with anemia in pregnancy and pregnancy induced hypertension in Lagos, Nigeria

Journal of Public Health in Africa ◽

10.4081/jphia.2014.286 ◽

2014 ◽

Vol 5 (2) ◽

Cited By ~ 1

Author(s):

Olusola Funmilayo Sotunde ◽

Silifat Ajoke Sanni ◽

Oluseye Olusegun Onabanjo ◽

Ibiyemi O. Olayiwola ◽

Mure Agbonlahor

Keyword(s):

Retrospective Study ◽

Birth Weight ◽

Sampling Technique ◽

Neonatal Health ◽

Pregnancy Induced Hypertension ◽

Health Profile ◽

Maternal Complications ◽

Induced Hypertension ◽

Anemia In Pregnancy ◽

In Pregnancy

Our study assessed the health profile of neonates in relation to anemia in pregnancy and pregnancy induced hypertension (PIH). This was a retrospective study where a systematic random sampling technique was used to select a total of 1046 case records of pregnant women registered for ante-natal care at Lagos Island Maternity Hospital, Lagos, Nigeria, between 2005 and 2009. Socio-demographic characteristics of the mothers, prevalence of anemia and PIH, and neonatal health profile were obtained from the case records and were analyzed using both descriptive and inferential statistics. Pearson product moment correlation was used to show the relationship (P≤0.05) between maternal complications and neonatal health profile. Majority (68.8%) of the mothers had anemia and 6.7 % had PIH. Majority (97.12%) of the neonates were live births and 2.88% of the neonates were still births, 65.4% of the women with still birth pregnancy outcome had anemia, and 34.6% had PIH. Majority (74%) of the neonates had birth weight within normal range (2.5-4.0 kg) and majority (68%) had normal Apgar score at 5 min of birth (7- 10). A positive correlation existed between the packed cell volume of the mother and the birth weight of the neonates (r=0.740, P≤0.05). A negative correlation existed between the incidence of PIH and the birth weight of the neonates (r=

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The Effectiveness and Cost-Effectiveness of Hepatitis C Screening for Migrants in the EU/EEA: A Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15092013 ◽

2018 ◽

Vol 15 (9) ◽

pp. 2013 ◽

Cited By ~ 12

Author(s):

Christina Greenaway ◽

Iuliia Makarenko ◽

Claire Abou Chakra ◽

Balqis Alabdulkarim ◽

Robin Christensen ◽

...

Keyword(s):

Cost Effectiveness ◽

Hepatitis C ◽

Lower Risk ◽

Linkage To Care ◽

Cost Effective ◽

Screening Tests ◽

European Economic Area ◽

The European Union ◽

Wide Range ◽

The Eu

Chronic hepatitis C (HCV) is a public health priority in the European Union/European Economic Area (EU/EEA) and is a leading cause of chronic liver disease and liver cancer. Migrants account for a disproportionate number of HCV cases in the EU/EEA (mean 14% of cases and >50% of cases in some countries). We conducted two systematic reviews (SR) to estimate the effectiveness and cost-effectiveness of HCV screening for migrants living in the EU/EEA. We found that screening tests for HCV are highly sensitive and specific. Clinical trials report direct acting antiviral (DAA) therapies are well-tolerated in a wide range of populations and cure almost all cases (>95%) and lead to an 85% lower risk of developing hepatocellular carcinoma and an 80% lower risk of all-cause mortality. At 2015 costs, DAA based regimens were only moderately cost-effective and as a result less than 30% of people with HCV had been screened and less 5% of all HCV cases had been treated in the EU/EEA in 2015. Migrants face additional barriers in linkage to care and treatment due to several patient, practitioner, and health system barriers. Although decreasing HCV costs have made treatment more accessible in the EU/EEA, HCV elimination will only be possible in the region if health systems include and treat migrants for HCV.

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Hepatitis C Virus in Pregnancy: Case Reports and Literature Review

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/s1064744995000731 ◽

1995 ◽

Vol 3 (6) ◽

pp. 248-251 ◽

Cited By ~ 1

Author(s):

Gary M. Joffe

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Vertical Transmission ◽

Case Reports ◽

Sexual Transmission ◽

Severity Of Illness ◽

The United States ◽

Maternal Disease ◽

In Pregnancy

Background: Hepatitis C virus (HCV) is now recognized as the cause of 90% of non-A, non-B (NANB) hepatitis. This virus is responsible for a large percentage of chronic persistent and chronic active hepatitis in the United States. Parenteral and sexual transmission are well described, so a significant population of pregnant patients is at risk. Vertical transmission of the virus to the fetus is dependent upon the level of maternal viremia.Case: The cases described in the following report demonstrate that fulminant disease may present in pregnancy. They also demonstrate the cofactors promoting the severity of illness, methods of diagnosis, potential treatment, and outcome of the infection.Conclusion: HCV may be encountered in pregnancy. Although most acute-phase illness will be self limiting, some patients will manifest liver failure during gestation. Because vertical transmission to the fetus is possible, the pediatrician should be informed of the maternal disease. Chronic hepatitis is almost the rule rather than the exception, so patients require close postpartum follow-up. Interferon, which may alter the course of the chronic disease, has been used on rare occasions in pregnancy.

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Interferon-α-2b + ribavirin cost effective for mild hepatitis C

PharmacoEconomics & Outcomes News ◽

10.1007/bf03269059 ◽

2001 ◽

Vol 295 (1) ◽

pp. 9-9

Keyword(s):

Hepatitis C ◽

Cost Effective ◽

Interferon Α

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Cytomegalovirus Screening in Pregnancy: A Cost-Effectiveness and Threshold Analysis

American Journal of Perinatology ◽

10.1055/s-0038-1676495 ◽

2018 ◽

Vol 36 (07) ◽

pp. 678-687 ◽

Cited By ~ 2

Author(s):

Catherine M. Albright ◽

Erika F. Werner ◽

Brenna L. Hughes

Keyword(s):

Cost Effectiveness ◽

Behavioral Intervention ◽

Universal Screening ◽

Cost Effective ◽

Base Case ◽

Design Decision ◽

Intervention Effectiveness ◽

Behavioral Counseling ◽

The Cost ◽

In Pregnancy

Objective To determine threshold cytomegalovirus (CMV) infectious rates and treatment effectiveness to make universal prenatal CMV screening cost-effective. Study Design Decision analysis comparing cost-effectiveness of two strategies for the prevention and treatment of congenital CMV: universal prenatal serum screening and routine, risk-based screening. The base case assumptions were a probability of primary CMV of 1% in seronegative women, hyperimmune globulin (HIG) effectiveness of 0%, and behavioral intervention effectiveness of 85%. Screen-positive women received monthly HIG and screen-negative women received behavioral counseling to decrease CMV seroconversion. The primary outcome was the cost per maternal quality-adjusted life year (QALY) gained with a willingness to pay of $100,000 per QALY. Results In the base case, universal screening is cost-effective, costing $84,773 per maternal QALY gained. In sensitivity analyses, universal screening is cost-effective only at a primary CMV incidence of more than 0.89% and behavioral intervention effectiveness of more than 75%. If HIG is 30% effective, primary CMV incidence can be 0.82% for universal screening to be cost-effective. Conclusion The cost-effectiveness of universal maternal screening for CMV is highly dependent on the incidence of primary CMV in pregnancy. If efficacious, HIG and behavioral counseling allow universal screening to be cost-effective at lower primary CMV rates.

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