Abstract
BackgroundInternational sustainable development goals for the elimination of viral hepatitis as a public health problem by 2030 highlight the need to optimize strategies for prevention, diagnosis and treatment of hepatitis B virus (HBV) infection. An important priority for Africa is to have affordable, accessible and sustainable prevention of mother to child transmission (PMTCT) programmes, delivering screening and treatment for antenatal women and implementing timely administration of HBV vaccine for their babies.MethodsWe developed a decision-analytic model simulating 10,000 singleton pregnancies to assess the cost-effectiveness of three possible strategies for deployment of tenofovir in pregnancy, in combination with routine infant vaccination: S1: no screening nor antiviral therapy; S2: screening and antiviral prophylaxis for all women who test HBsAg-positive; S3: screening for HBsAg, followed by HBeAg testing and antiviral prophylaxis for women who are HBsAg-positive and HBeAg-positive. Our outcome was cost per infant HBV infection avoided and the analysis followed a healthcare perspective.ResultsBased on 10,000 pregnancies, S1 predicts 45 infants would be HBV-infected at six months of age, compared to 21 and 28 infants in S2 and S3, respectively. Relative to S1, S2 had an incremental cost of $3940 per infection avoided. S3 led to more infections and higher costs.ConclusionGiven the long-term health burden for individuals and economic burden for society associated with chronic HBV infection, screening pregnant women and providing tenofovir for all who test HBsAg+ may be a cost-effective strategy for South Africa and other low/middle income settings.
Highlights
International sustainable development goals for the elimination of viral hepatitis as a public health problem by 2030 highlight the need to optimize strategies for prevention, diagnosis and treatment of hepatitis B virus (HBV) infection
Current recommended practice includes screening antenatal women for infection using hepatitis B surface antigen (HBsAg), and risk-stratification based on further laboratory tests for hepatitis B e-Antigen (HBeAg) and/or HBV DNA viral load (VL), which can be used to stratify the risk of vertical transmission
In order to identify the most cost-effective approach to HBV prevention of mother to child transmission (PMTCT) we have evaluated antenatal screening for HBV infection using standard laboratory assays for HBsAg and treating HBsAg-positive women with Tenofovir disoproxil fumarate (TDF), based on South Africa as a model situation
Summary
International sustainable development goals for the elimination of viral hepatitis as a public health problem by 2030 highlight the need to optimize strategies for prevention, diagnosis and treatment of hepatitis B virus (HBV) infection. PMTCT guidelines suggest administering a three dose HBV vaccine to all infants with the first dose administered within 24 h of birth and two other doses provided at 6 and 10 weeks respectively, as well as administering hepatitis B immunoglobulin (HBIg) to high risk babies in the first day of life [7, 8]. Together, these strategies reduce the rate of vertical transmission by 85–95% [9], representing a crucial component of efforts towards HBV elimination [10,11,12]. Tenofovir disoproxil fumarate (TDF) has a track record of safety and efficacy in this setting [15, 16], and is included in some guidelines for HBV PMTCT [8, 17]
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