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. 2011 Sep;118(3):655-662.
doi: 10.1097/AOG.0b013e31822ad2c2.

Cost-effectiveness of maternal treatment to prevent perinatal hepatitis B virus transmission

Elizabeth Ramsey Unal  1 , Gweneth B Lazenby, Anne E Lintzenich, Kit N Simpson, Roger Newman, Laura Goetzl
Affiliations

Cost-effectiveness of maternal treatment to prevent perinatal hepatitis B virus transmission

Elizabeth Ramsey Unal et al. Obstet Gynecol. 2011 Sep.

Abstract

Objective: To estimate the cost-effectiveness of maternal lamivudine or hepatitis B immune globulin (HBIG) treatment, in addition to standard neonatal immunoprophylaxis, for the prevention of perinatal hepatitis B virus transmission.

Methods: A decision-tree model was created to estimate the cost-effectiveness of maternal administration of either lamivudine or HBIG in the third trimester to prevent perinatal hepatitis B transmission compared with no maternal treatment. The model was first estimated for each treatment using overall transmission rates, and then stratified by maternal hepatitis B virus DNA viral load.

Results: The model estimated that for each 100 hepatitis B surface antigen positive pregnant women treated with lamivudine, 9.7 cases of chronic hepatitis B virus infections are prevented, with a cost-savings of $5,184 and 1.3 life-years gained per patient treated. For HBIG, 9.5 cases of chronic hepatitis B virus infections are prevented for each 100 pregnant women treated, with a cost-savings of $5,887 and 1.2 life-years gained per patient treated. Under baseline assumptions, lamivudine remains cost-saving unless the reduction in perinatal transmission is less than 18.5%, and HBIG remains cost-saving unless the reduction in perinatal transmission is less than 9.6%.

Conclusion: In this decision analysis, administration of lamivudine or HBIG to hepatitis B surface antigen positive pregnant women for the prevention of perinatal transmission of hepatitis B is cost-savings across a wide range of assumptions.

Level of evidence: III.

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