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. 2023 Jul 19;13(7):e067275.
doi: 10.1136/bmjopen-2022-067275.

Cost-effectiveness of tenofovir prophylaxis during pregnancy for the elimination of mother-to-child transmission of the hepatitis B virus: real-world analysis from Thailand

Chawisar Janekrongtham  1   2 , Niramon Punsuwan  3 , Phanthanee Thitichai  2 , Cheewanan Lertpiriyasuwat  3 , Wirichada Pan-Ngum  4   5 , Kittiyod Poovorawan  6 , Jureeporn Jantarapakde  7 , Pisit Tangkijvanich  8
Affiliations

Cost-effectiveness of tenofovir prophylaxis during pregnancy for the elimination of mother-to-child transmission of the hepatitis B virus: real-world analysis from Thailand

Chawisar Janekrongtham et al. BMJ Open. .

Abstract

Objective: Despite implementing hepatitis B immunoglobulin (HBIG) and vaccination, data suggest it would not be sufficient to reach the elimination targets. Tenofovir disoproxil fumarate (TDF) has been added to the Thai national standards of care for prevention of transmission of the hepatitis B virus during birth. To optimise national strategies in Thailand, we assessed TDF's effectiveness for prevention of mother-to-child transmission and conducted cost-effectiveness analyses of different TDF-based strategies.

Research design and methods: We retrospectively reviewed medical records of mother and infant pairs whose mothers were positive for hepatitis B e-antigen (HBeAg) and received TDF to prevent maternal transmission of viral hepatitis B during 2018-2020. Based on the available data on transmission rate, we also applied a decision tree to estimate the cost-effectiveness of different TDF-based strategies to eligible mothers. These included: (1) HBIG for all hepatitis B virus (HBV) exposed infants; (2) HBIG for only infants of HBeAg-positive mothers ('HBIG for e-positive') and (3) without HBIG to infants ('HBIG-free'). The incremental cost-effectiveness ratio between the different strategies and baseline intervention without TDF was calculated. The one-way sensitivity analysis was used to adjust prevalence of HBeAg-positive mothers, cost of HBIG, cost of TDF and transmission rate.

Results: Of 223 infants enrolled, 212 (95.0%) received HBIG, while 11 (5.0%) did not. None of the infants had chronic HBV infection. The most cost-saving intervention was 'HBIG-free' followed by 'HBIG for e-positive'. The one-way sensitivity demonstrated that the results were reasonably robust to changes. The cost-saving was greater with a higher hepatitis B virus surface antigen (HBsAg) prevalence. The HBIG-free strategy remained best at 0%-1.4% transmission rates, meeting the additional target for eliminations.

Conclusion: The study is the first cost-effectiveness analyses to provide evidence supporting an HBIG-free strategy in an antiviral era. This approach should be considered to prevent mother-to-child transmission in resource-constrained settings, particularly in countries with a high HBsAg prevalence.

Keywords: Cost-effectiveness; HBIG-free; Tenofovir Disoproxil Fumarate (TDF; Thailand; elimination of maternal tochildtransmission (EMTCT; hepatitis B immune globulin (HBIG; viral hepatitis B.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Decision tree models used in cost-effectiveness analyses. HBeAg, hepatitis B envelope antigen; HBIG, hepatitis B immunoglobulins; HBsAg, hepatitis B surface antigen; HBV hepatitis B virus; TDF, tenofovir disoproxil fumarate.
Figure 2
Figure 2
ICER of three TDF-based interventions comparing to Thailand’s willingness to pay threshold (160 000 THB per QALY). +Cost-effectiveness threshold in Thailand is 160 000 THB per QALY, and QALY of chronic HBV infection was 13.6 years. ICER, incremental cost-effectiveness ratio; TDF, tenofovir disoproxil fumarate.
Figure 3
Figure 3
Comparing transmission rates of best two interventions (HBIG-free intervention, HBIG for e-positive) by adjusting transmission rate of the best intervention (HBIG-free intervention). HBeAg, hepatitis B virus e antigen; HBIG, hepatitis B immunoglobulin.
See this image and copyright information in PMC

References

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