{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T13:44:32Z","timestamp":1790516672675,"version":"4.1.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0011129","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,3,3]],"date-time":"2023-03-03T00:00:00Z","timestamp":1677801600000}}],"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T00:00:00Z","timestamp":1676937600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Human T-cell leukemia virus type 1 (HTLV-1) causes adult T-cell leukemia-lymphoma (ATL) and HTLV-1-associated myelopathy-tropical spastic paraparesis (HAM\/TSP) with a poor prognosis. This study aimed to evaluate the cost-effectiveness and health impact of HTLV-1 antenatal screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methodology\/Principal findings<\/jats:title>\n                    <jats:p>A state-transition model was developed for HTLV-1 antenatal screening and no screening over a lifetime horizon from a healthcare payer perspective. A hypothetical cohort of 30-year-old individuals was targeted. The main outcomes were costs, quality-adjusted life-years (QALYs), life expectancy life-years (LYs), incremental cost-effectiveness ratios (ICERs), HTLV-1 carriers, ATL cases, HAM\/TSP cases, ATL-associated deaths, and HAM\/TSP-associated deaths. The willingness-to-pay (WTP) threshold was set at US$50,000 per QALY gained. In the base-case analysis, HTLV-1 antenatal screening (US$76.85, 24.94766 QALYs, 24.94813 LYs, ICER; US$40,100 per QALY gained) was cost-effective compared with no screening (US$2.18, 24.94580 QALYs, 24.94807 LYs). Cost-effectiveness was sensitive to the maternal HTLV-1 seropositivity rate, HTLV-1 transmission rate with long-term breastfeeding from HTLV-1 seropositive mothers to children, and the cost of the HTLV-1 antibody test. HTLV-1 antenatal screening was cost-effective when the maternal HTLV-1 seropositivity rate was greater than 0.0022 and the cost of the HTLV-1 antibody test was lower than US$94.8. Probabilistic sensitivity analysis using a second-order Monte-Carlo simulation showed that HTLV-1 antenatal screening was 81.1% cost-effective at a WTP threshold of US$50,000 per QALY gained. For 10,517,942 individuals born between 2011 and 2021, HTLV-1 antenatal screening costs US$785 million, increases19,586 QALYs and 631 LYs, and prevents 125,421 HTLV-1 carriers, 4,405 ATL cases, 3,035 ATL-associated deaths, 67 HAM\/TSP cases, and 60 HAM\/TSP-associated deaths, compared with no screening over a lifetime.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusion\/Significance<\/jats:title>\n                    <jats:p>HTLV-1 antenatal screening is cost-effective and has the potential to reduce ATL and HAM\/TSP morbidity and mortality in Japan. The findings strongly support the recommendation for HTLV-1 antenatal screening as a national infection control policy in HTLV-1 high-prevalence countries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0011129","type":"journal-article","created":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T14:03:14Z","timestamp":1676988194000},"page":"e0011129","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":15,"title":["Cost-effectiveness of human T-cell leukemia virus type 1 (HTLV-1) antenatal screening for prevention of mother-to-child transmission"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5200-4300","authenticated-orcid":true,"given":"Akiko","family":"Kowada","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,2,21]]},"reference":[{"key":"pntd.0011129.ref001","doi-asserted-by":"crossref","first-page":"4567","DOI":"10.1111\/cas.14658","article-title":"Prognosis of patients with adult T-cell leukemia\/lymphoma in Japan: A nationwide hospital-based study","volume":"111","author":"Y Imaizumi","year":"2020","journal-title":"Cancer Sci"},{"key":"pntd.0011129.ref002","doi-asserted-by":"crossref","first-page":"5458","DOI":"10.1200\/JCO.2007.11.9958","article-title":"VCAP-AMP-VECP compared with biweekly CHOP for adult T-cell leukemia-lymphoma: Japan Clinical Oncology Group Study JCOG9801.","volume":"25","author":"K Tsukasaki","year":"2007","journal-title":"J Clin Oncol."},{"key":"pntd.0011129.ref003","doi-asserted-by":"crossref","first-page":"11685","DOI":"10.1073\/pnas.1920346117","article-title":"Mortality and risk of progression to adult T cell leukemia\/lymphoma in HTLV-1-associated myelopathy\/tropical spastic paraparesis","volume":"117","author":"M Nagasaka","year":"2020","journal-title":"Proc Natl Acad Sci. 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