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.
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.
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%.
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.
The use of maternal lamivudine or hepatitis B immune globulin to prevent perinatal hepatitis B virus transmission is not only cost-effective but also, under most assumptions, cost-saving.
From the Departments of Obstetrics and Gynecology, Pediatrics, and Health Science and Research, Medical University of South Carolina, Charleston, South Carolina.
Corresponding author: Elizabeth Ramsey Unal, MD, 96 Jonathan Lucas Street, Suite 634 MSC 619, Charleston SC 29425; e-mail: firstname.lastname@example.org.
Financial Disclosure The authors did not report any potential conflicts of interest.