Cost-effectiveness of maternal treatment to prevent perinatal hepatitis B virus transmission.

Abstract

OBJECTIVE:

To estimate the cost-effectiveness of maternal lamivudine or hepatitis B immune globulin (HBIG) treatment, in addition to standard neonatal immunoprophylaxis, for the prevention of perinatal hepatitis B virus transmission.

METHODS:

A decision-tree model was created to estimate the cost-effectiveness of maternal administration of either lamivudine or HBIG in the third trimester to prevent perinatal hepatitis B transmission compared with no maternal treatment. The model was first estimated for each treatment using overall transmission rates, and then stratified by maternal hepatitis B virus DNA viral load.

RESULTS:

The model estimated that for each 100 hepatitis B surface antigen positive pregnant women treated with lamivudine, 9.7 cases of chronic hepatitis B virus infections are prevented, with a cost-savings of $5,184 and 1.3 life-years gained per patient treated. For HBIG, 9.5 cases of chronic hepatitis B virus infections are prevented for each 100 pregnant women treated, with a cost-savings of $5,887 and 1.2 life-years gained per patient treated. Under baseline assumptions, lamivudine remains cost-saving unless the reduction in perinatal transmission is less than 18.5%, and HBIG remains cost-saving unless the reduction in perinatal transmission is less than 9.6%.

CONCLUSION:

In this decision analysis, administration of lamivudine or HBIG to hepatitis B surface antigen positive pregnant women for the prevention of perinatal transmission of hepatitis B is cost-savings across a wide range of assumptions.

LEVEL OF EVIDENCE:

III.

• Authors: Elizabeth Ramsey Unal, Gweneth B Lazenby, Anne E Lintzenich, Kit N Simpson, Roger Newman, Laura Goetzl
• Journal: Obstetrics and gynecology (Obstet Gynecol) Vol. 118 Issue 3 Pg. 655-662 (Sep 2011) ISSN: 1873-233X [Electronic] United States
• PMID: 21860297 (Publication Type: Journal Article)

Chemical References

• DNA, Viral
• Immunoglobulins
• Reverse Transcriptase Inhibitors
• Lamivudine

Topics

• Adult
• Cost Savings
• Cost-Benefit Analysis
• DNA, Viral (analysis)
• Decision Trees
• Female
• Hepatitis B (economics, prevention & control, transmission)
• Humans
• Immunoglobulins (economics, therapeutic use)
• Infant, Newborn
• Lamivudine (economics, therapeutic use)
• Pregnancy
• Pregnancy Complications, Infectious (economics, prevention & control)
• Pregnancy Trimester, Third
• Reverse Transcriptase Inhibitors (economics, therapeutic use)
• Viral Load