Research Spotlight: Cost-Effectiveness of Early Intervention: Treating Perinatally Acquired Hepatitis C Virus in 3-Year-Olds

Megan Rose Curtis, MD, and Andrea Ciaranello, MD, MPH, physician-investigators in the Division of Infectious Diseases at Massachusetts General Hospital, are co-authors of a recently published study in JAMA Pediatrics, Cost-Effectiveness of Strategies for Treatment Timing for Perinatally Acquired Hepatitis C Virus. Dr. Ciaranello is also the James and Audrey Foster MGH Research Scholar 2022-2027.

What Was the Question You Set Out to Answer With This Study

Hepatitis C virus (HCV) can cause chronic infection, damaging the liver.

HCV is increasing among pregnant individuals, with increased risk of perinatal transmission to their infants. Safe and effective treatment is available for children as young as three, yet most children are not screened, and few have access to HCV treatment.

In this mathematical modeling study, we investigated whether treating three-year-olds with perinatally acquired hepatitis C virus (HCV) is more cost-effective compared to treating at older ages.

What Methods or Approach Did You Use?

This is a mathematical modeling study that simulates 1,000 children with perinatally acquired HCV from the age of three throughout their lifetime.

By leveraging published data on the natural history of pediatric HCV, treatment effectiveness, and healthcare costs, we were able to project the long-term clinical and economic consequences of delaying HCV treatment from the eligible age of three until the ages of 6, 12, 18, or never receiving treatment.

What Did You Find?

The study revealed that initiating treatment earlier was projected to improve life expectancy and reduce lifetime healthcare costs.

Earlier intervention yielded significantly improved clinical outcomes; for instance, in the cohort of 1,000 children with perinatally acquired HCV, treating at the age of three prevented 89 projected cases of cirrhosis, 27 cases of hepatocellular carcinoma, and 74 liver-related deaths compared to deferring treatment until the age of six.

What are the Implications?

The CDC recently recommended that providers screen infants with perinatal HCV exposure with an RNA test at 2-6 months of age (the previous recommendation was to wait until after 18 months for an antibody test).

With these updated guidelines, clinicians will likely identify more children with perinatally-acquired HCV.

Consequently, clinicians and families of these children may find themselves deliberating when to initiate treatment.

This study can assist decision-makers as they weigh the pros and cons of offering HCV treatment when a child becomes eligible at 3 years old. They can consider the probability that the child will be lost to follow up between that visit and later ages, and the subsequent health and economic costs of a missed opportunity for HCV cure.

What are the Next Steps?

We hope to focus the next set of questions on the cost-effectiveness of treating HCV during pregnancy.

The prenatal period is a unique window of opportunity. Individuals who might not typically engage with the healthcare system tend to seek care more consistently during this time.

 Additionally, treating HCV during pregnancy may potentially prevent perinatal transmission and avert the health complications and economic costs described in this analysis.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In July 2022, Mass General was named #8 in the U.S. News & World Report list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system.