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Universal screening for hepatitis B may be cost-effective strategy
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Vaccination with hepatitis B immunoglobulin for neonates of hepatitis B surface antigen-carrier mothers is a cost-effective addition to universal vaccination, new research suggests.
Researchers developed a model to estimate the clinical and economic outcomes of the hepatitis B virus for a hypothetical cohort of 100,000 neonates. The model focused on the study of four different strategies: strategy V (universal vaccination); strategy S (strategy V plus screening for hepatitis B surface antigen [HBsAg] and hepatitis B immunoglobulin [HBIG] treatment for HBsAg-positive mothers’ neonates); strategy E (strategy V plus screening for hepatitis B e-antigen [HBeAg], HBIG for HBeAg-positive mothers’ neonates); strategy S&E (strategy V plus screening for HBsAg then HBeAg, HBIG for all HBeAg-positive, and some HBeAg-negative/HBsAg-positive mothers’ neonates).
“Targeting HBIG to neonates of higher risk HBeAg-positive mothers may be preferred where willingness to pay is moderate,” researchers said. “However, in very resource-limited settings, universal vaccination alone is optimal.”
Researchers found that strategy S prevented the most infections. Strategy S&E was the second most effective followed by E, then V. Researchers added that in most cases, the most effective strategies also were the most costly.
As carrier rate declined, the willingness-to-pay above which strategy S was cost-effective rose and was less than $4,000 per infection averted for carrier rates greater than 5%.
“The willingness-to-pay below which strategy V was optimal also increased as carrier rate declined, from $1,400 at 30% carrier rate to $3,100 at 5% carrier rate,” researchers said.
The strategies involving strategy E were best for an intermediate range of willingness-to-pay that narrowed as carrier rate decreased.
“Our results suggest that maternal screening for HBsAg and HBIG treatment of neonates of HBV carrier mothers could be a cost-effective addition to universal vaccination in settings in which health facility infrastructure can support such an intervention,” researchers said. “Particularly if the expected future treatment costs of HBV-infective children are moderately high, more intensive prevention efforts using screening and HBIG are likely to provide good value by averting those treatment costs.”
Disclosure: The researchers report no relevant financial disclosures.