Lower diagnostic costs needed for HBV peripartum antiviral prophylaxis to be effective
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Key takeaways:
- HBV birth dose vaccination with antiviral prophylaxis in pregnant women with high viral load could avert 1.1 million new infections by 2030.
- The strategy would be cost-effective by 2100 in only 26% of countries.
The addition of peripartum antiviral prophylaxis to reduce neonatal hepatitis B virus infection could have “substantial extra health benefits,” although decreased diagnostic costs are needed to make this strategy cost-effective.
“WHO’s Global Health Sector Strategy on Viral Hepatitis set a target for elimination of mother-to-child transmission of HBV, with the aim to reach a prevalence of less than 0.1% in children younger than 5 years by 2030,” Shevanthi Nayagam, PhD, a clinical fellow in the School of Public Health at Imperial College London, and colleagues wrote in The Lancet Gastroenterology & Hepatology. “The primary recommendation to accomplish this target has been the use of a birth dose of HBV vaccine given to the neonate within 24 hours of birth (HepB-BD), and a further two or three vaccine doses usually given to the infant as part of the Expanded Program on Immunizations.”
They continued: “However, HepB-BD (even with hepatitis B immunoglobulin) does not completely interrupt transmission if the mother has a high HBV viral load. Prophylaxis of transmission by adding antiviral therapy for the mother during pregnancy (ie, peripartum antiviral prophylaxis) has been shown to be effective against mother-to-child transmission of HBV in women who are classified as being at high risk of transmission.”
Nayagam and colleagues used a dynamic simulation model of the HBV epidemic in 110 countries to assess the impact and cost-effectiveness of administration of peripartum antiviral prophylaxis (PAP) to pregnant women who are hepatitis B surface antigen positive (HBsAG). Researchers assessed three strategies — PAP for women with a high viral load (PAP-VL), PAP for HBeAG-positive women (PAP-HBeAG) and PAP for all pregnant women who are HBsAG-positive (PAP-universal) — compared with HepB-BD alone.
Researchers calculated cost-effectiveness ratios in averted cost per disability-adjusted life-year (DALY) for each country and compared that with country-specific cost-effectiveness thresholds.
Results showed increasing HepB-BD had the “greatest incremental effect” in every evaluated region and could avert approximately 6 million (95% uncertainty interval [UI], 5.6-6.5) new neonatal infections as well as 2,969 DALYs (95% UI, 2,605-3,371) from 2024 to 2030. Adding PAP-VL to HepB-BD could avert an extra 1.1 million (95% UI, 1-1.2) new neonatal infections by 2030 and nearly 3.2 million (95% UI, 3-3.4) new neonatal infections and 8.8 million (95% UI, 7.8-9.7) DALYs by 2100.
“From 2015 to 2030, HepB-BD could result in more than a 75% reduction in new chronic HBV infections in all WHO regions, and PAP-VL could result in more than a 90% reduction in all regions, which is consistent with WHO targets for a 90% reduction by 2030 in the incidence of new chronic HBV infections,” Nayagam and colleagues wrote.
However, researchers noted that the PAP-VL strategy could be cost-effective by 2100 in only 26% of countries evaluated if costs stay the same, but in 70% of countries if diagnostic and monitoring costs were lowered by approximately 60% to 75%.
“This study has shown that HepB-BD remains the most cost-effective intervention for the prevention of mother-to-child HBV transmission,” Nayagam and colleagues wrote. “A PAP strategy could have substantial extra health benefits but might not be cost-effective in all countries without further reductions in the cost of diagnostics.”
They added, “Promising theoretical strategies of offering prophylaxis to all pregnant women who are HBsAg positive without accompanying risk stratification could also improve feasibility and cost-effectiveness, depending on the prevailing costs of diagnostics and of providing antiviral therapy and the extent to which this strategy might be achieved requires further research on implementation.”
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