Abstract
BackgroundData on the cost effectiveness of hepatitis B virus (HBV) screening and vaccination strategies for prevention of vertical transmission of HBV in resource limited settings is sparse.MethodsA decision tree model of HBV prevention strategies utilised data from a cohort of 7071 pregnant women on the Thailand-Myanmar border using a provider perspective. All options included universal HBV vaccination for newborns in three strategies: (1) universal vaccination alone; (2) universal vaccination with screening of women during antenatal visits with rapid diagnostic test (RDT) plus HBV immune globulin (HBIG) administration to newborns of HBV surface antigen positive women; and (3) universal vaccination with screening of women during antenatal visits plus HBIG administration to newborns of women testing HBV e antigen positive by confirmatory test. At the time of the study, the HBIG after confirmatory test strategy was used. The costs in United States Dollars (US$), infections averted and incremental cost effectiveness ratios (ICERs) were calculated and sensitivity analyses were conducted. A willingness to pay threshold of US$1200 was used.ResultsThe universal HBV vaccination was the least costly option at US$4.33 per woman attending the clinic. The HBIG after (RDT) strategy had an ICER of US$716.78 per infection averted. The HBIG after confirmatory test strategy was not cost-effective due to extended dominance. The one-way sensitivity analysis showed that while the transmission parameters and cost of HBIG had the biggest impact on outcomes, the HBIG after confirmatory test only became a cost-effective option when a low test cost was used or a high HBIG cost was used. The probabilistic sensitivity analysis showed that HBIG after RDT had an 87% likelihood of being cost-effective as compared to vaccination only at a willingness to pay threshold of US$1200.ConclusionsHBIG following confirmatory test is not a cost-effective strategy for preventing vertical transmission of HBV in the Thailand-Myanmar border population. By switching to HBIG following rapid diagnostic test, perinatal infections will be reduced by nearly one third. This strategy may be applicable to similar settings for marginalized populations where the confirmatory test is not logistically possible.
Highlights
Data on the cost effectiveness of hepatitis B virus (HBV) screening and vaccination strategies for prevention of vertical transmission of HBV in resource limited settings is sparse
An estimated 5–15% of perinatal infections occur in-utero, which vaccination at birth does not prevent [6]; an estimated 90% of perinatal infections could be averted through infant HBV vaccination alongside administration of HBV immunoglobulin (HBIG) to the infant [7,8,9,10,11,12]
The cohort costs ranged from United States Dollars (US$)21,673.15 for the vaccine only strategy to US$47,477.10 for the HBIG after rapid diagnostic test (RDT) strategy; these are equivalent to US$4.33 to US$9.50 per woman presenting at the clinic
Summary
Data on the cost effectiveness of hepatitis B virus (HBV) screening and vaccination strategies for prevention of vertical transmission of HBV in resource limited settings is sparse. An estimated 240 million individuals are chronically infected with hepatitis B virus (HBV) worldwide [1, 2]. Transmission occurs through unprotected sex and body fluids [4], including the birth process, which leads to the majority of perinatal infections. Individuals who are HBV e-antigen positive (HBeAg+) are at the highest risk of transmitting to others. Of those who acquire the infection perinatally, 65% become chronic carriers of the disease and are at a higher risk of morbidity and mortality as compared to 28% in those born to HBeAg- mothers [5]. The reduction of mother to child transmission is a core intervention in the World Health Organisation (WHO) global health sector strategy on viral hepatitis, which proposes expansion of coverage from current its level of 38% to 90% by 2030 [13]
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