Reappraisal of national Hepatitis C Guidelines in pregnancy is needed
(11th Nov 2021) A study published on 27th Oct 2021 in BJOG (See Publication HERE) investigated if risk factor based screening in pregnancy is failing to identify Hepatitis C virus (HCV) infection and assessed the cost effectiveness of universal screening. Key results from the study showed that the prevalence of HCV infection in pregnant women in the Dublin region has declined by 65% over the past two decades, risk factor-based screening misses a significant proportion of infections and a change to universal maternal screening for HCV would be cost-effective.
Speaking about the study and findings, Prof Aiden McCormick, Consultant Hepatologist, SVUH, Clinical Professor, UCD School of Medicine and the Study’s Principal Investigator said: "On the basis of this study, we are pleased to announce that the HSE has funded universal antenatal hepatitis screening in the National Maternity and Rotunda Hospitals. This represents a prime example of collaborative research involving the HSE, HIQA, UCD and the voluntary hospitals and which has an immediate and significant impact on patient care. Further studies will determine whether this change to universal screening should be rolled out nationally."
In the study, which was conducted in these two urban referral maternity hospitals, 4,655 samples were analysed retrospectively to determine how many pregnant women with HCV may go undiagnosed with the current risk factor-based screening policy in Ireland. Samples were tested for HCV antibodies in anonymised sera from pregnant women who had been screened for Hepatitis B and HIV but not HCV. Samples found to contain HCV antibodies were tested for HCV antigen to confirm active infection. The prevalence of 0.43% for HCV antibody and 0.11% for HCV antigen in pregnant women who had not been tested on basis of risk factors, across the two hospitals was found.
A cost benefit analysis was also performed, in line with health technology assessment guidelines, to determine the longer-term cost-effectiveness of universal versus risk factor antenatal testing, based on the results of this maternity study. This component of the study showed that a change from risk-factor based, to universal screening would be very cost-effective for the patient catchment area of these two large Dublin maternity hospitals. The incremental cost-effective ratio was estimated at €3,315 per QALY gained.
Risk factors for the development of HCV include IV drug use, having piercings and tattoos, a history of jaundice or receiving blood products, immigrating from an area with a high prevalence of HCV or having a high-risk partner. The Irish National Screening Guidelines for HCV which were published in 2017, recommended risk factor based, rather than universal screening, for pregnant women.
Professor McCormick explained: "Treatments for HCV have dramatically improved in recent years and it is now considered an easily curable disease. It is therefore vital to identify infected pregnant women, through universal screening, many of whom are unaware that they have infected. They can then be offered appropriate curative treatment following delivery.”
This study was conducted in the National Maternity and Rotunda Hospitals, Dublin. These two hospitals are considered large, urban maternity units with between 7,500 and 9,000 births annually and cover a geographical area including Dublin and parts of neighbouring counties (Kildare, Meath and Wicklow) The study was funded by the National Hepatitis C Treatment Programme.