title: Antenatal lamivudine to reduce perinatal hepatitis B transmission: a cost-effectiveness analysis.
abstract: OBJECTIVE
  This study aimed to determine whether administration of lamivudine to pregnant women with chronic hepatitis B in the third trimester is a cost-effective strategy in preventing perinatal transmission.
  
  
  METHODS
  We developed a decision analysis model to compare the cost-effectiveness of 2 management strategies for chronic hepatitis B in pregnancy: (1) expectant management or (2) lamivudine administration in the third trimester. We assumed that lamivudine reduced perinatal transmission by 62%.
  
  
  RESULTS
  Our Markov model demonstrated that lamivudine administration is the dominant strategy. For every 1000 infected pregnant women treated with lamivudine, $337,000 is saved and 314 quality-adjusted life-years are gained. For every 1000 pregnancies with maternal hepatitis B, lamivudine prevents 21 cases of hepatocellular carcinoma and 5 liver transplants in the offspring. The model remained robust in sensitivity analysis.
  
  
  CONCLUSIONS
  Antenatal lamivudine administration to pregnant patients with hepatitis B is cost-effective, and frequently cost-saving, under a wide range of circumstances.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Unzila A
authors.initials: UA
authors.lastname: Nayeri
authors.forename: Erika F
authors.initials: EF
authors.lastname: Werner
authors.forename: Christina S
authors.initials: CS
authors.lastname: Han
authors.forename: Christian M
authors.initials: CM
authors.lastname: Pettker
authors.forename: Edmund F
authors.initials: EF
authors.lastname: Funai
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Thung
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018562:Disease Transmission, Infectious / Q000191:economics* / Q000517:prevention & control*; D005260:Female; D019694:Hepatitis B, Chronic / Q000191:economics* / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D019259:Lamivudine / Q000191:economics* / Q000627:therapeutic use*; D011247:Pregnancy; D018894:Reverse Transcriptase Inhibitors / Q000191:economics* / Q000627:therapeutic use*
chemical_list: D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine