Cost-effectiveness of testing hepatitis B-positive pregnant women for hepatitis B e antigen or viral load.
OBJECTIVE
To estimate the cost-effectiveness of testing pregnant women with hepatitis B (hepatitis B surface antigen [HBsAg]-positive) for hepatitis B e antigen (HBeAg) or hepatitis B virus (HBV) DNA, and administering maternal antiviral prophylaxis if indicated, to decrease breakthrough perinatal HBV transmission from the U.S. health care perspective.


METHODS
A Markov decision model was constructed for a 2010 birth cohort of 4 million neonates to estimate the cost-effectiveness of two strategies: testing HBsAg-positive pregnant women for 1) HBeAg or 2) HBV load. Maternal antiviral prophylaxis is given from 28 weeks of gestation through 4 weeks postpartum when HBeAg is positive or HBV load is high (10 copies/mL or greater). These strategies were compared with the current recommendation. All neonates born to HBsAg-positive women received recommended active-passive immunoprophylaxis. Effects were measured in quality-adjusted life-years (QALYs) and all costs were in 2010 U.S. dollars.


RESULTS
The HBeAg testing strategy saved $3.3 million and 3,080 QALYs and prevented 486 chronic HBV infections compared with the current recommendation. The HBV load testing strategy cost $3 million more than current recommendation, saved 2,080 QALYs, and prevented 324 chronic infections with an incremental cost-effectiveness ratio of $1,583 per QALY saved compared with the current recommendations. The results remained robust over a wide range of assumptions.


CONCLUSIONS
Testing HBsAg-positive pregnant women for HBeAg or HBV load followed by maternal antiviral prophylaxis if HBeAg-positive or high viral load to reduce perinatal hepatitis B transmission in the United States is cost-effective.
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Lin
L
Fan
Kwame
K
Owusu-Edusei
Sarah F
SF
Schillie
Trudy V
TV
Murphy
D019072:Antibiotic Prophylaxis / Q000191:economics*; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004279:DNA, Viral / Q000097:blood / Q000191:economics; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006513:Hepatitis B e Antigens / Q000097:blood / Q000191:economics; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000097:blood / Q000188:drug therapy / Q000191:economics* / Q000635:transmission*; D006801:Humans; D007116:Immunization, Passive / Q000191:economics*; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000191:economics* / Q000517:prevention & control*; D011247:Pregnancy; D019057:Quality-Adjusted Life Years; D012698:Serologic Tests / Q000191:economics; D014611:Vaccination / Q000191:economics*; D019562:Viral Load / Q000191:economics
D000998:Antiviral Agents; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens