Cost-Effectiveness of Testing Hepatitis B–Positive Pregnant Women for Hepatitis B e Antigen or Viral Load

Details

• Alternative Title:
  Obstet Gynecol
• Personal Author:
  Fan, Lin ; Owusu-Edusei, Kwame ; Schillie, Sarah F. ; Murphy, Trudy V.
• Description:
  OBJECTIVE
  
  To estimate the cost-effectiveness of testing pregnant women with hepatitis B (hepatitis B surface antigen [HBsAg]-positive) for hepatitis B e antigen (HBeAg) or hepatitis B virus (HBV) DNA, and administering maternal antiviral prophylaxis if indicated, to decrease breakthrough perinatal HBV transmission from the U.S. health care perspective.
  
  METHODS
  
  A Markov decision model was constructed for a 2010 birth cohort of 4 million neonates to estimate the cost-effectiveness of two strategies: testing HBsAg-positive pregnant women for 1) HBeAg or 2) HBV load. Maternal antiviral prophylaxis is given from 28 weeks of gestation through 4 weeks postpartum when HBeAg is positive or HBV load is high (108 copies/mL or greater). These strategies were compared with the current recommendation. All neonates born to HBsAg-positive women received recommended active-passive immunoprophylaxis. Effects were measured in quality-adjusted life-years (QALYs) and all costs were in 2010 U.S. dollars.
  
  RESULTS
  
  The HBeAg testing strategy saved $3.3 million and 3,080 QALYs and prevented 486 chronic HBV infections compared with the current recommendation. The HBV load testing strategy cost $3 million more than current recommendation, saved 2,080 QALYs, and prevented 324 chronic infections with an incremental cost-effectiveness ratio of $1,583 per QALY saved compared with the current recommendations. The results remained robust over a wide range of assumptions.
  
  CONCLUSION
  
  Testing HBsAg-positive pregnant women for HBeAg or HBV load followed by maternal antiviral prophylaxis if HBeAg-positive or high viral load to reduce perinatal hepatitis B transmission in the United States is cost-effective.
  
  
• Subjects:
  Antibiotic Prophylaxis Antiviral Agents Cost-Benefit Analysis DNA, Viral Female Hepatitis B, Chronic Hepatitis B E Antigens Hepatitis B Surface Antigens Hepatitis B Virus Humans Immunization, Passive Infant, Newborn Infectious Disease Transmission, Vertical Pregnancy Quality-Adjusted Life Years Serologic Tests Vaccination Viral Load

  More +
• Source:
  Obstet Gynecol. 123(5):929-937
• Pubmed ID:
  24785842
• Pubmed Central ID:
  PMC4682356
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHSUnited States/
• Volume:
  123
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:794d02f698ba4e5f8f772872d97c94faf2ae966650725033e0abc64047222575
• Download URL:
  https://stacks.cdc.gov/view/cdc/36897/cdc_36897_DS1.pdf
• File Type:
  [PDF - 315.22 KB ]