Cost-Effectiveness of Maternal Treatment to Prevent Perinatal Hepatitis B Virus Transmission

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http://journals.lww.com/greenjournal/Abstract/2011/09000/Cost_Effectiveness_of_M\

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Obstetrics & Gynecology:

September 2011 - Volume 118 - Issue 3 - p 655–662

doi: 10.1097/AOG.0b013e31822ad2c2

Original Research

Cost-Effectiveness of Maternal Treatment to Prevent Perinatal Hepatitis B Virus

Transmission

Unal, Ramsey MD; Lazenby, Gweneth B. MD; Lintzenich, Anne E. MD;

Simpson, Kit N. DrPH; Newman, MD; Goetzl, MD, MPH

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

© 2011 The American College of Obstetricians and Gynecologists