Cost-effectiveness analysis of preventing mother-to-child transmission of hepatitis B by injecting hepatitis B immune globulin

ABSTRACTIn light of sustainable development goals for 2030, an important priority for Africa is to have affordable, accessible and sustainable hepatitis B virus (HBV) prevention of mother to child transmission (PMTCT) programmes, delivering screening and treatment for antenatal women and implementing timely administration of HBV vaccine for their babies. We developed a decision-analytic model simulating 10,000 singleton pregnancies to assess the cost-effectiveness of three possible strategies for deployment of tenofovir in pregnancy, in combination with routine infant vaccination: S1: no screening nor antiviral therapy; S2: screening and antiviral prophylaxis for all women who test HBsAg-positive; S3: screening for HBsAg, followed by HBeAg testing and antiviral prophylaxis for women who are HBsAg-positive and HBeAg-positive. Our outcome was cost per infant HBV infection avoided and the analysis followed a healthcare perspective. S1 predicts 45 infants would be HBV-infected at six months of age, compared to 21 and 28 infants in S2 and S3, respectively. Relative to S1, S2 had an incremental cost of $3,940 per infection avoided. S3 led to more infections and higher costs. Given the long-term health burden for individuals and economic burden for society associated with chronic HBV infection, screening pregnant women and providing tenofovir for all who test HBsAg+ may be a cost-effective strategy for South Africa.

Download Full-text

Integrated approach for triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis is highly effective and cost-effective: an economic evaluation

International Journal of Epidemiology ◽

10.1093/ije/dyz037 ◽

2019 ◽

Vol 48 (4) ◽

pp. 1327-1339 ◽

Cited By ~ 4

Author(s):

Lei Zhang ◽

Yusha Tao ◽

Joseph Woodring ◽

Kim Rattana ◽

Samreth Sovannarith ◽

...

Keyword(s):

Cost Effectiveness ◽

Hepatitis B ◽

Antenatal Care ◽

Pregnant Women ◽

Cost Effective ◽

Integrated Approach ◽

Mother To Child Transmission ◽

Child Transmission ◽

Total Cost ◽

Mother To Child

Abstract Background The Regional Framework for Triple Elimination of Mother-to-Child Transmission (EMTCT) of HIV, Hepatitis B (HBV) and Syphilis in Asia and the Pacific 2018-30 was endorsed by the Regional Committee of WHO Western Pacific in October 2017, proposing an integrated and coordinated approach to achieve elimination in an efficient, coordinated and sustainable manner. This study aims to assess the population impacts and cost-effectiveness of this integrated approach in the Cambodian context. Methods Based on existing frameworks for the EMTCT for each individual infection, an integrated framework that combines infection prevention procedures with routine antenatal care was constructed. Using decision tree analyses, population impacts, cost-effectiveness and the potential reduction in required resources of the integrated approach as a result of resource pooling and improvements in service coverage and coordination, were evaluated. The tool was assessed using simulated epidemiological data from Cambodia. Results The current prevention programme for 370,000 Cambodian pregnant women was estimated at USD$2.3 ($2.0–$2.5) million per year, including the duration of pregnancy and up to 18 months after delivery. A model estimate of current MTCT rates in Cambodia was 6.6% (6.2–7.1%) for HIV, 14.1% (13.1–15.2%) for HBV and 9.4% (9.0–9.8%) for syphilis. Integrating HIV and syphilis prevention into the existing antenatal care framework will reduce the total time required to provide this integrated care by 19% for health care workers and by 32% for pregnant women, resulting in a net saving of $380,000 per year for the EMTCT programme. This integrated approach reduces HIV and HBV MTCT to 6.1% (5.7–6.5%) and 13.0% (12.1–14.0%), respectively, and substantially reduces syphilis MCTC to 4.6% (4.3–5.0%). Further introduction of either antiviral treatment for pregnant women with high viral load of HBV, or hepatitis B immunoglobulin (HBIG) to exposed newborns, will increase the total cost of EMTCT to $4.4 ($3.6–$5.2) million and $3.3 ($2.7–$4.0) million per year, respectively, but substantially reduce HBV MTCT to 3.5% (3.2–3.8%) and 5.0% (4.6–5.5%), respectively. Combining both antiviral and HBIG treatments will further reduce HBV MTCT to 3.4% (3.1–3.7%) at an increased total cost of EMTCT of $4.5 ($3.7–$5.4) million per year. All these HBV intervention scenarios are highly cost–effective ($64–$114 per disability-adjusted life years averted) when the life benefits of these prevention measures are considered. Conclusions The integrated approach, using antenatal, perinatal and postnatal care as a platform in Cambodia for triple EMTCT of HIV, HBV and syphilis, is highly cost-effective and efficient.

Download Full-text

Update in management of hepatitis B in pregnancy and prevention of mother to child hepatitis B transmission

Thai Journal of Hepatology ◽

10.30856/th.jhep2018vol1iss3_01 ◽

2018 ◽

Vol 1 (3) ◽

pp. 1-8

Author(s):

Naichaya Chamroonkul

Keyword(s):

Chronic Hepatitis ◽

Viral Load ◽

Hepatitis B ◽

Chronic Hepatitis B ◽

High Viral Load ◽

World Population ◽

Hepatitis B Infection ◽

Mother To Child Transmission ◽

Child Transmission ◽

Mother To Child

Even with two decades of widespread using hepatitis B vaccination, chronic hepatitis B remains a major global health problem. In Thailand, the prevalence of chronic hepatitis B infection was down from 8 - 10% in last decade to 5% recently. Failure to control mother to child transmission is one of the important barriers to the total elimination of hepatitis B infection from world population. In the majority, vertical transmission can be prevented with a universal screening program, immunoprophylaxis by administration of hepatitis B vaccine and hepatitis B immunoglobulin (HBIg) for babies born to mothers with HBV. However, in mothers with a high viral load, the chance of immunoprophylaxis failure remains high. To date, there are standard recommendations by all international liver societies including AASLD, EASL and APASL suggest introducing an antiviral agent during the third trimester to CHB pregnant women with a high viral load. Previous US FDA pregnancy category B agents such as Tenofovir and Telbivudine are allowed through all trimesters of pregnancy and are effective for prevention of mother to child transmission. Breastfeeding for patients who receive antiviral agents can be allowed after a risk-benefit discussion with the patient and family.

Download Full-text