title: Cost-effectiveness analysis of prophylactic lamivudine use in preventing vertical transmission of hepatitis B virus infection.
abstract: BACKGROUND
  As neonates born to mothers with positive hepatitis B e antigen may not be completely protected by hepatitis B vaccination, prophylactic lamivudine use in mothers with high viraemia has been proposed. However, the overall effectiveness and the balance between cost and benefit for such a prophylactic strategy have rarely been addressed.
  
  
  OBJECTIVE
  Using a review of recent literature, we aimed to assess the cost effectiveness, from the Taiwanese societal perspective, of administering prophylactic lamivudine to mothers to reduce vertical transmission of hepatitis B virus and its long-term sequelae in neonates.
  
  
  METHODS
  A meta-analysis of three randomized controlled trials was conducted to evaluate the efficacy of lamivudine versus placebo. A Markov decision model was constructed in which in both treatment arms infants received active and passive immunoprophylaxis. An economic evaluation was performed to calculate costs, acute infections averted, and QALYs gained. Probabilistic sensitivity analyses were conducted and a cost-effectiveness acceptability curve drawn. All these analyses were from the societal perspective. Costs ($US) were valued in year 2008 prices.
  
  
  RESULTS
  Supplemental lamivudine use gained an additional 0.0024 QALYs and averted 0.23 acute infections per birth compared with the routine active-passive immunization without lamivudine. The cost-effectiveness analysis suggested that the use of additional prophylactic lamivudine dominated the routine strategy. The acceptability curve suggested that the probability of being cost effective under the willingness-to-pay threshold of $US20,000 was 94%.
  
  
  CONCLUSIONS
  This analysis suggests that supplemental use of lamivudine in mothers with high hepatitis B viraemia is effective in reducing vertical transmission and may be cost effective, from a Taiwanese societal perspective, compared with the routine active-passive immunization without lamivudine.
authors.affiliation: Hsin-Chu General Hospital, Department of Health, Executive Yuan, Taipei, Taiwan.
authors.forename: Hui-Fang
authors.initials: HF
authors.lastname: Hung
authors.forename: Hsiu-Hsi
authors.initials: HH
authors.lastname: Chen
mesh_terms: D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006509:Hepatitis B / Q000188:drug therapy / Q000191:economics* / Q000517:prevention & control / Q000635:transmission; D006515:Hepatitis B virus / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D019259:Lamivudine / Q000191:economics* / Q000627:therapeutic use; D011322:Primary Prevention / Q000191:economics*; D019057:Quality-Adjusted Life Years; D013624:Taiwan
chemical_list: D000998:Antiviral Agents; D019259:Lamivudine
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