The use of an antiviral prophylaxis strategy in pregnant women with high hepatitis B virus infection viral load was more cost-effective for reducing the number of perinatal transmissions vs. current and universal vaccination strategies, according to a new study.
“Perinatal transmission is one of the most important modes of transmission [of HBV]. ... Although recommended prophylaxis with vaccination and hepatitis B immune globulin starting within hours of birth prevents most of perinatal infections, infants born to women with high HBV DNA load are still at risk. Antiviral treatment during pregnancy provides a promising opportunity to prevent perinatal transmission among high risk women and reduce the burden of chronic hepatitis B infection.,” Lin Fan, PhD, from the national center for HIV/AIDS, viral hepatitis, STD and TB prevention, told Healio.com/Hepatology.
Fan and colleagues used a decision tree and Markov model to estimate the cost-effectiveness of three strategies for the prevention of perinatal HBV transmission. In the universal HepB strategy, all infants receive the first dose of the HBV vaccination series before hospital discharge and complete the series over time, no pregnant woman is screened for HBsAg or other HBV markers and no infants receive hepatitis B immunoglobulin (HBIG). For the current strategy, all pregnant women receive prenatal screening for HBsAg and all infants born to HBsAg-positive mothers receive HepB and HBIG within 12 hours of birth, followed by completion of the vaccination series. The third antiviral prophylaxis strategy includes all pregnant women receiving prenatal screening for HBsAg and all pregnant women with high HBV DNA viral load undergo antiviral prophylaxis for 4 months, beginning in the last trimester and up to 1 month after birth.
The researchers estimated the number of infants with perinatal HBV and their lifetime complications under each strategy. The Markov model was used to measure the lifetime costs and effects associated with chronic HBV for infants with perinatal HBV and were measured in quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICER).
Results showed the current strategy prevented 1,006 chronic HBV infections and saved 13,600 QALYs compared with the universal HepB strategy (ICER: $6,957 per QALY saved). The antiviral prophylaxis strategy was also more cost-effective compared with the universal HepB strategy with an ICER of $6,376 per QALY saved. The antiviral prophylaxis also prevented an additional 489 chronic infections and saved 800 QALYs and $2.8 million compared with the current strategy, indicating it was the most cost-effective of the three strategies.
“The current strategy was dominated by the antiviral prophylaxis strategy because the antiviral prophylaxis strategy accumulated more QALYs and cost less than the current strategy,” the researchers wrote.
When the current strategy was compared with the universal HepB strategy, researchers found that as prevalence of HBsAg decreased, the current strategy became less cost-effective. At 0.2% HBsAg prevalence, the current strategy had an ICER of $15,552 per QALY saved compared with the universal HepB strategy. At a 7% prevalence, the current strategy had an ICER of $2,886 per QALY saved compared with the universal HepB strategy.
The researchers indicated the antiviral prophylaxis strategy accumulated more QALYs and cost less than the current strategy. However, when perinatal transmission rate for the current strategy decreased to 1%, the ICER of the antiviral prophylaxis strategy increased to $269,796 per QALY saved. When the reduction of perinatal transmission from antiviral prophylaxis decreased to 20%, the ICER of the antiviral strategy increased to $97,749 per QALY saved. When 10% of pregnant women with high HBV DNA viral load received antiviral prophylaxis, the ICER of the antiviral strategy increased to $68,509 per QALY saved.
“The risk of perinatal transmission is highest among infants born to women with high HBV DNA load or HBeAg, even after receiving recommended prophylaxis. Women with high viral load should be informed and offered antiviral treatment during the third trimester of pregnancy to lower their HBV DNA and decrease the risk of perinatal transmission,” Fan said. – by Melinda Stevens
Disclosure: The researchers report no relevant financial disclosures.