Tenofovir disoproxil fumarate in pregnancy for prevention of mother to child transmission of hepatitis B in a rural setting on the Thailand-Myanmar border: a cost-effectiveness analysis

Autor: Michèle van Vugt, Marieke Bierhoff, Marcus J. Rijken, Pachinee Kobphan, Kanlaya Sriprawa, Rose McGready, Angela Devine, Chaisiri Angkurawaranon, Francois Nosten
Přispěvatelé: Graduate School, Infectious diseases, AII - Infectious diseases, APH - Global Health, APH - Quality of Care
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Adult
Rural Population
HBsAg
Pediatrics
medicine.medical_specialty
Cost effectiveness
Cost-Benefit Analysis
Myanmar
Antiviral therapy
medicine.disease_cause
lcsh:Gynecology and obstetrics
Antiviral Agents
03 medical and health sciences
Young Adult
0302 clinical medicine
Pregnancy
medicine
Humans
030212 general & internal medicine
Pregnancy Complications
Infectious
Tenofovir
lcsh:RG1-991
health care economics and organizations
Hepatitis
Hepatitis B virus
Rapid diagnostic test
business.industry
Obstetrics and Gynecology
Reproducibility of Results
virus diseases
Perinatal infection
Hepatitis B
Viral Load
medicine.disease
Thailand
Infectious Disease Transmission
Vertical
digestive system diseases
HBeAg
030211 gastroenterology & hepatology
Female
Cost-effectiveness
business
Viral load
Research Article
Zdroj: BMC pregnancy and childbirth, 21(1):157. BioMed Central
BMC Pregnancy and Childbirth
BMC Pregnancy and Childbirth, Vol 21, Iss 1, Pp 1-12 (2021)
ISSN: 1471-2393
Popis: BackgroundHepatitis B Virus (HBV) is transmitted from mother to child which can be prevented via birth dose vaccine combined with three follow up hepatitis B vaccines, hepatitis B immunoglobulins (HBIG), and maternal antiviral treatment with Tenofovir Disoproxil Fumarate (TDF). This study evaluates the cost effectiveness of six strategies to prevent perinatal HBV transmission in a resource limited setting (RLS) on the Thailand-Myanmar border.MethodsThe cost effectiveness of six strategies was tested by a decision tree model in R. All strategies included birth and follow up vaccinations and compared cost per infection averted against two willingness to pay thresholds: one-half and one gross domestic product (GDP) per capita. Strategies were: 1) Vaccine only, 2) HBIG after rapid diagnostic test (RDT): infants born to HBsAg+ are given HBIG, 3) TDF after RDT: HBsAg+ women are given TDF, 4) TDF after HBeAg test: HBeAg+ women are given TDF, 5) TDF after high HBV DNA: women with HBV DNA > 200,000 are given TDF, 6) HBIG & TDF after high HBV DNA: women with HBV DNA > 200,000 are given TDF and their infants are given HBIG. One-way and probabilistic sensitivity analyses were conducted on the cost-effective strategies.ResultsVaccine onlywas the least costly option withTDF after HBeAg teststrategy as the only cost-effective alternative.TDF after HBeAg testhad an incremental cost-effectiveness ratio of US$1062; which would not be considered cost-effective with the lower threshold of one-half GDP per capita. The one-way sensitivity analysis demonstrated that the results were reasonably robust to changes in single parameter values. The PSA showed thatTDF after HBeAg testhad an 84% likelihood of being cost effective at a willingness to pay threshold of one GDP per capita per infection averted.ConclusionsWe found thatTDF after HBeAg testhas the potential to be cost-effective if TDF proves effective locally to prevent perinatal HBV transmission. The cost of TDF treatment and reliability of the RDT could be barriers to implementing this strategy. WhileTDF after RDTmay be a more feasible strategy to implement in RLS,TDF after HBeAg testis a less costly option.
Databáze: OpenAIRE
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