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Improvements possible for perinatal hepatitis B prevention program
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The current CDC perinatal hepatitis B prevention program, funded through Section 317, is a cost-effective use of resources, but a program that reached all pregnant women would provide additional public health benefits, according to results of a recent analysis.
Carolina Barbosa, PhD, of RTI International, and colleagues evaluated the cost-effectiveness of the perinatal hepatitis B prevention program (PHBPP) to determine perinatal infections and childhood infections from infants born to hepatitis B surface antigen (HBsAg)-positive women, quality-adjusted life-years (QALY), lifetime costs, and incremental cost per QALY gained.
The no PHBPP strategy accrued lifetimes costs of screening all pregnant women ($60,018,562); cost of routine vaccination ($1,943,035); and the long-term medical costs associated with late diagnosis of perinatal and childhood infections ($52,364,741). Higher lifetime costs were seen with the PHBPP strategy ($120,319,857) but also had better health outcomes compared with no PHBPP.
Costs of PHBPP included:
- Costs of screening all pregnant women ($60,018,562);
- Identifying infants born to HBsAg-positive women ($9,304,521);
- Managing those infants ($8,977,101);
- Cost of post-exposure prophylaxis with hepatitis B immunoglobulin and hepatitis B vaccine with additional hepatitis B series and post-vaccination serologic testing for infants who failed to respond to the initial hepatitis B vaccine series ($4,221,035);
- And long-term hepatitis B-related medical costs ($37,798,101).
Fewer total infections (2,351) were seen with PHBPP, as well as less QALYs lost (2,304), and incremental cost-effectiveness ratio of $2,602 per QALY compared with no PHBPP.
PHBPP would be considered cost-effective if all decision makers were willing to pay at least $2,602 per QALY gained.
“The simulation of a perfect PHBPP scenario showed that an expansion of the current recommendations to all infants at risk would lead to a reduced number of perinatal and childhood infections, with an [incremental cost-effectiveness ratio] of $3,517 per QALY,” the researchers wrote. “Our model predicted that the current PHBPP represented a cost-effective use of resources, and that expansion of the program could represent an economically efficient method to prevent further morbidity and mortality.”
Disclosure: The study was funded in part by CDC. The researchers report no relevant financial disclosures.
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