Abstract
Background. Hepatitis B virus (HBV) infections are perinatally transmitted from chronically infected mothers. Supplemental antiviral therapy during late pregnancy with lamivudine (LAM), telbivudine (LdT), or tenofovir (TDF) can substantially reduce perinatal HBV transmission compared to postnatal immunoprophylaxis (IP) alone. However, the cost-effectiveness of these measures is not clear.Aim. This study evaluated the cost-effectiveness from a societal perspective of supplemental antiviral agents for preventing perinatal HBV transmission in mothers with high viral load (>6 log10 copies/mL).Methods. A systematic review and network meta-analysis were performed for the risk of perinatal HBV transmission with antiviral therapies. A decision analysis was conducted to evaluate the clinical and economic outcomes in China of four competing strategies: postnatal IP alone (strategy IP), or in combination with perinatal LAM (strategy LAM + IP), LdT (strategy LdT + IP), or TDF (strategy TDF + IP). Antiviral treatments were administered from week 28 of gestation to 4 weeks after birth. Outcomes included treatment-related costs, number of infections, and quality-adjusted life years (QALYs). One- and two-way sensitivity analyses were performed to identify influential clinical and cost-related variables. Probabilistic sensitivity analyses were used to estimate the probabilities of being cost-effective for each strategy.Results. LdT + IP and TDF + IP averted the most infections and HBV-related deaths, and gained the most QALYs. IP and TDF + IP were dominated as they resulted in less or equal QALYs with higher associated costs. LdT + IP had an incremental $2,891 per QALY gained (95% CI [$932–$20,372]) compared to LAM + IP (GDP per capita for China in 2013 was $6,800). One-way sensitivity analyses showed that the cost-effectiveness of LdT + IP was only sensitive to the relative risk of HBV transmission comparing LdT + IP with LAM + IP. Probabilistic sensitivity analyses demonstrated that LdT + IP was cost-effective in most cases across willingness-to-pay range of $6,800 ∼ $20,400 per QALY gained.Conclusions. For pregnant HBV-infected women with high levels of viremia, supplemental use of LdT during late pregnancy combined with postnatal IP for infants is cost-effective in China.
Highlights
Chronic hepatitis B virus (HBV) infection is a serious public health problem in China that affects ∼93 million people (7.18% of the population), representing a quarter of all Hepatitis B virus (HBV)-infected people worldwide (Liang et al, 2009)
In the long-term, the more effective strategies resulted in fewer instances of hepatocellular carcinoma and HBV-related death, and increased the quality-adjusted life years (QALYs) (Table 4)
Antiviral treatment as prophylaxis for perinatal hepatitis B transmission is recommended in updated guidelines from the European Association for the Study of the Liver, Asian Pacific Association for the Study of the Liver, and the National Institute for Health and Care Excellence (European Association For The Study Of The Liver, 2012; Liaw et al, 2012; Sarri et al, 2013)
Summary
Chronic hepatitis B virus (HBV) infection is a serious public health problem in China that affects ∼93 million people (7.18% of the population), representing a quarter of all HBV-infected people worldwide (Liang et al, 2009). The predominant mode of HBV infection involves perinatal transmission from chronically infected mothers to their infants (Gambarin-Gelwan, 2007; Patton & Tran, 2014; Stevens et al, 1975). This can be suppressed by passive immunization with hepatitis B immunoglobulin (HBIG) administered within 12 h of birth and active immunization with a three-dose HBV vaccination series (Lee et al, 2006). For pregnant HBV-infected women with high levels of viremia, supplemental use of LdT during late pregnancy combined with postnatal IP for infants is cost-effective in China
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call