Cost-Effectiveness Analysis of Prophylactic Lamivudine Use in Preventing Vertical Transmission of Hepatitis B Virus Infection

Hung, Hui-Fang; Chen, Chien-Jen

doi:10.2165/11586470-000000000-00000

Cited by 12 publications

(17 citation statements)

References 57 publications

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“…7 Because prevalence data for women with HBV load higher or lower than 10 6 copies/mL are limited, we used 10 6 copies/mL or greater as the lower limit of value defined as high viral load for sensitivity analyses. 7,18,25,27,28 Approximately 10–30% of persons with chronic HBV have viral load 10 8 copies/mL or greater. 7,25–27 Consequently, we chose 20% prevalence as our base estimate.…”

Section: Methodsmentioning

confidence: 99%

“…7,18,25,27,28 Approximately 10–30% of persons with chronic HBV have viral load 10 8 copies/mL or greater. 7,25–27 Consequently, we chose 20% prevalence as our base estimate. The estimated perinatal transmission rates for pregnant women with HBV load 10 8 copies/mL or greater ranges from 7 to 32%; we used 15% as the base estimate.…”

Section: Methodsmentioning

confidence: 99%

“…The estimated perinatal transmission rates for pregnant women with HBV load 10 8 copies/mL or greater ranges from 7 to 32%; we used 15% as the base estimate. 7,25–27 …”

Section: Methodsmentioning

confidence: 99%

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

Fan

Owusu-Edusei

Schillie

et al. 2014

Obstetrics &Amp; Gynecology

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

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

Fan

Owusu-Edusei

Schillie

et al. 2014

Obstetrics &Amp; Gynecology

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“…By using the estimated results of the five-state model for the Studies 1 and 2 together with other parameters and cost from a previous study (Hung and Chen 2011) as detailed in Appendix 2, Table 6 shows the results of cost, QALYs and the incremental cost-effectiveness ratio. As far as the ICER indicators are concerned, two preventive strategies dominated over no intervention group regardless of study selected because the ICER values were negative, indicating more gain in QALY but less cost (cost-saving) for the two intervention groups as compared with no intervention.…”

Section: Results Of Economic Appraisal On Preventive Strategiesmentioning

confidence: 99%

Stochastic model for hepatitis B virus infection through maternal (vertical) and environmental (horizontal) transmission with applications to basic reproductive number estimation and economic appraisal of preventive strategies

Hung

Wang

Yen

et al. 2013

Stoch Environ Res Risk Assess

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Elucidating the temporal natural history of Hepatitis B virus (HBV) infection provides not only useful information for assessing the spread of HBV infection but also a bedrock for economic appraisal of population-based preventive strategies (such as universal vaccination). HBV transmissions are transmitted through the maternal (vertical) route and environmental (horizontal) route. As the infection process from susceptible to active virus replication and finally to recovery state or to carrier state through both routes is not directly observable, mathematical models were therefore proposed to quantitatively elucidate the dynamic process of HBV infection with time. We began with a simple two-state model (from susceptible to infection) and further developed a five-state (including susceptible, latent phase, active viral replication, carrier, and recovery states) stochastic process to quantify the dynamics of HBV infection, making allowances for a mixed proportion of vertical and horizontal transmissions. The data used in the estimation, which were collected before implementation of a policy for universal HBV vaccination, were derived from several previous serum prevalence studies, including both low (northern) and high (southern) HBV prevalence areas, in Taiwan. The parameters obtained from stochastic models were converted to compute the basic reproductive number (R 0 ) in each study to indicate the extent of the spread of HBV infection. By linking the temporal natural history of HBV infection with the previously established Markov process for the sequelae of HBV infection (chronic hepatitis infection, liver cirrhosis, and hepatocelluar carcinoma), we developed a Markov cycle decision tree to evaluate the two populationbased preventive strategies related to vaccination and maternal lamivudine use with a cost-effectiveness analysis. In the five-state model, horizontal transmission was found to contribute more to HBV infection than vertical transmission in the northern area (59 vs. 41 %), whereas vertical transmission was more likely than horizontal transmission in the southern area (80 vs. 20 %). After considering the parameters of the two transmission routes, annual infection rate (person-years) for susceptible subjects was higher in the northern area (0.35) than the southern area (0.011). A similar finding was noted for annual rate of the transition from the latent period to active viral replications (1.12 in the northern area and 0.072 in the southern area). Annual rate of the conversion from active viral replication to the carrier state was higher in the southern area (0.184) than the northern area (0.119). Annual recovery rates were 0.014 in the northern area and 0.024 in the southern area for the carrier and 0.048 and 0.088 for transient viremia. The R 0 at age 30 using the parameters obtained from the five-state stochastic model was estimated as 4.88 in the northern and 7.03 in the southern area. Regarding the findings of economic appraisal, both preventive strategies were cost-saving, yielding the n...

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“…A number of studies have found that the use of lamivudine and telbivudine for MTCT prophylaxis in pregnant HBVinfected women with high levels of viremia is cost effective both in high-income countries such as the USA and Taiwan and in China, a middle-income country [70][71][72]. Without pre-existing advanced liver fibrosis/cirrhosis or hepatitis flare, cessation of antiviral therapy is recommended at delivery, 4-12 weeks after delivery, or when breastfeeding is begun [14].…”

Section: Other Aspects Of Antiviral Treatment During Pregnancymentioning

confidence: 99%

Hepatitis B During Pregnancy in Endemic Areas: Screening, Treatment, and Prevention of Mother-to-Child Transmission

Chamroonkul

Piratvisuth

2017

Pediatr Drugs

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The proper management of pregnant women infected with hepatitis B virus (HBV) is necessary to prevent maternal and fetal morbidity and mortality and to protect the baby from HBV infection. In the majority of cases, vertical transmission can be prevented with a universal screening program, HBV vaccine immunoprophylaxis, and administration of hepatitis B immunoglobulin (HBIg) for babies born to mothers with HBV. However, in mothers with a high viral load (>200,000 or >1,000,000 IU/ml, depending on the guideline), the chance of immunoprophylaxis failure remains high. The standard recommendation is to give an antiviral agent during the third trimester in these patients. US FDA pregnancy category B agents such as tenofovir and telbivudine are allowed through all trimesters of pregnancy. Breastfeeding for patients who receive antiviral agents can be allowed after a risk-benefit discussion with the patient.

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Cost-Effectiveness Analysis of Prophylactic Lamivudine Use in Preventing Vertical Transmission of Hepatitis B Virus Infection

Abstract: This analysis suggests that supplemental use of lamivudine in mothers with high hepatitis B viraemia is effective in reducing vertical transmission and may be cost effective, from a Taiwanese societal perspective, compared with the routine active-passive immunization without lamivudine.

Cited by 12 publications

References 57 publications

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

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

Stochastic model for hepatitis B virus infection through maternal (vertical) and environmental (horizontal) transmission with applications to basic reproductive number estimation and economic appraisal of preventive strategies

Hepatitis B During Pregnancy in Endemic Areas: Screening, Treatment, and Prevention of Mother-to-Child Transmission

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