title: Cost-effectiveness of augmenting universal hepatitis B vaccination with immunoglobin treatment.
abstract: OBJECTIVE
  To compare the cost-effectiveness of hepatitis B virus (HBV) control strategies combining universal vaccination with hepatitis B immunoglobulin (HBIG) treatment for neonates of carrier mothers.
  
  
  METHODS
  Drawing on Taiwan's experience, we developed a decision-analytic model to estimate the clinical and economic outcomes for 4 strategies: (1) strategy V-universal vaccination; (2) strategy S-V plus screening for hepatitis B surface antigen (HBsAg) and HBIG treatment for HBsAg-positive mothers' neonates; (3) strategy E-V plus screening for hepatitis B e-antigen (HBeAg), HBIG for HBeAg-positive mothers' neonates; (4) strategy S&E-V plus screening for HBsAg then HBeAg, HBIG for all HBeAg-positive, and some HBeAg-negative/HBsAg-positive mothers' neonates.
  
  
  RESULTS
  Strategy S averted the most infections, followed by S&E, E, and V. In most cases, the more effective strategies were also more costly. The willingness-to-pay (WTP) above which strategy S was cost-effective rose as carrier rate declined and was <$4000 per infection averted for carrier rates >5%. The WTP below which strategy V was optimal also increased as carrier rate declined, from $1400 at 30% carrier rate to $3100 at 5% carrier rate. Strategies involving E were optimal for an intermediate range of WTP that narrowed as carrier rate declined.
  
  
  CONCLUSIONS
  HBIG treatment for neonates of HBsAg carrier mothers is likely to be a cost-effective addition to universal vaccination, particularly in settings with adequate health care infrastructure. Targeting HBIG to neonates of higher risk HBeAg-positive mothers may be preferred where WTP is moderate. However, in very resource-limited settings, universal vaccination alone is optimal.
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
authors.forename: Solomon Chih-Cheng
authors.initials: SC
authors.lastname: Chen
authors.forename: Mehlika
authors.initials: M
authors.lastname: Toy
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Yeh
authors.forename: Jung-Der
authors.initials: JD
authors.lastname: Wang
authors.forename: Stephen
authors.initials: S
authors.lastname: Resch
mesh_terms: D015415:Biomarkers / Q000097:blood; D002353:Carrier State / Q000097:blood / Q000175:diagnosis; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D003906:Developing Countries; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control* / Q000635:transmission; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000191:economics*; D006513:Hepatitis B e Antigens / Q000097:blood; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage / Q000191:economics*; D007155:Immunologic Factors / Q000008:administration & dosage / Q000191:economics*; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000191:economics / Q000517:prevention & control*; D008403:Mass Screening / Q000191:economics / Q000379:methods; D032541:Mass Vaccination / Q000191:economics* / Q000379:methods; D018803:Models, Economic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000175:diagnosis*; D013624:Taiwan
chemical_list: D015415:Biomarkers; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D006513:Hepatitis B e Antigens; D007136:Immunoglobulins; D007155:Immunologic Factors; C045213:hepatitis B hyperimmune globulin