Global Health Seminar: Decision-analytic model for Human T-lymphotropic virus 1 (HTLV-1) antenatal screening in the UK

Event details

Abstract

HTLV-1 is a lifelong retroviral infection transmitted via bodily fluids, including breastfeeding. It can lead to severe late-onset disease, such as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T-cell leukaemia/lymphoma (ATLL). Although UK prevalence is low, targeted antenatal screening has been proposed for pregnant women at increased risk of infection to prevent mother-to-child transmission.

In this seminar, we present a systematic review of the association between HTLV-1 infection and adverse health outcomes, alongside an exploratory decision-analytic model evaluating the clinical impact, harms, and cost-effectiveness of targeted antenatal screening.

Fifteen cohort studies (29,335 participants) were included in the systematic review of health outcomes associated with HTLV-1 infection. No studies were conducted in the UK, with nearly all being undertaken in countries where the HTLV-1 virus is endemic. Most studies were of low or unclear methodological quality. A pairwise meta-analysis of individual effect estimates suggested an association between HTLV-1 infection and increased all-cause mortality (pooled effect estimate from 7 studies 1.62, 95% CI 1.41 to 1.87, I²=0). Consistent evidence was lacking for cause-specific mortality and morbidity outcomes, precluding further meta-analysis.

The model estimated that targeted screening could prevent 41 infant infections annually. Over time, this would avert one case of HAM/TSP and three cases of ATLL. However, screening was associated with increased costs and small net losses in quality-adjusted life years (QALYs), primarily driven by the psychological impact of being aware of an incurable lifelong infection. However, even when this disutility was excluded, screening remained cost-ineffective.

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Speakers: Susan O'Meara and Rob Hodgson, CRD University of York

Susan O'Meara's profile

Rob Hodgson's profile