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Skip Navigation LinksHome > September 2011 - Volume 118 - Issue 3 > Cost-Effectiveness of Maternal Treatment to Prevent Perinata...
Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e31822ad2c2
Original Research

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

Unal, Elizabeth Ramsey MD; Lazenby, Gweneth B. MD; Lintzenich, Anne E. MD; Simpson, Kit N. DrPH; Newman, Roger MD; Goetzl, Laura MD, MPH

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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 by The American College of Obstetricians and Gynecologists.

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