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Prevention of hepatitis B mother-to-child transmission in Namibia: A cost-effectiveness analysis
Cynthia Raissa Tamandjou Tchuem1, Monique Ingrid Andersson2, Charles Shey Wiysonge3
1Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Insights
Preventing mother-to-child hepatitis B virus (HBV) transmission in Africa requires cost-effective strategies. Universal birth dose vaccination plus HBIG, and maternal antiviral prophylaxis with HBeAg testing, are cost-effective interventions to avert infant HBV infections.
Area of Science:
- Hepatology
- Public Health
- Health Economics
Background:
- Hepatitis B virus (HBV) mother-to-child transmission (MTCT) persists in Africa despite available vaccines.
- Perinatal HBV infection significantly increases the risk of hepatocellular carcinoma in children.
- Cost-effectiveness of interventions is crucial for widespread implementation in resource-limited settings.
Purpose of the Study:
- To evaluate the cost-effectiveness of different HBV MTCT prevention strategies in Africa.
- To identify the most effective and economically viable interventions for HBV MTCT elimination.
Main Methods:
- A Markov model was developed to simulate costs and health outcomes of four HBV MTCT prevention strategies.
- Interventions included universal birth dose (BD) vaccination, BD vaccination with hepatitis B immunoglobulin (HBIG), and maternal antiviral prophylaxis with sequential viral load or HBeAg testing.
- Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs) compared to the Namibian cost per disability-adjusted life year (DALY) averted threshold.
Main Results:
- Universal BD vaccination plus targeted HBIG (ICER: $1909.03/DALY averted) and maternal antiviral prophylaxis with sequential HBeAg testing (ICER: $2598.90/DALY averted) were found to be cost-effective.
- Maternal antiviral prophylaxis with sequential HBeAg testing demonstrated superior effectiveness in preventing HBV MTCT.
- The analysis indicated that HBV MTCT elimination is achievable through combined active (vaccination) and passive (immunoglobulin/antiviral) immunization.
Conclusions:
- Combining universal birth dose vaccination with targeted HBIG, or employing maternal antiviral prophylaxis guided by HBeAg testing, represents a cost-effective approach to preventing HBV MTCT.
- Maternal antiviral prophylaxis with HBeAg testing is the preferred intervention for maximizing effectiveness.
- Development of low-cost diagnostic tests is essential to identify women who would benefit most from antiviral therapy, facilitating HBV MTCT elimination.
Abstract:
Despite access to a safe and effective vaccine, mother-to-child transmission (MTCT) of hepatitis B virus (HBV) persists in Africa. This is of concern since perinatally-infected infants are at highest risk of developing hepatocellular carcinoma, a life-threatening consequence of chronic HBV infection. While tools to prevent HBV MTCT are available, the cost implications of these interventions need consideration prior to implementation. A Markov model was developed to determine the costs and health outcomes of (1) universal HBV birth dose (BD) vaccination, (2) universal BD vaccination and targeted hepatitis B immunoglobulin (HBIG), (3) maternal antiviral prophylaxis using sequential HBV viral load testing added to HBV BD vaccination and HBIG, and (4) maternal antiviral prophylaxis using sequential HBeAg testing combined with HBV BD vaccination and HBIG. Health outcomes were assessed as the number of paediatric infections averted and disability-adjusted life years (DALYs) averted. Primary cost data included consumables, human resources, and hospital facilities. HBV epidemiology, transitions probabilities, disability weights, and the risks of HBV MTCT were extracted from the literature. Incremental cost-effectiveness ratios (ICERs) were calculated to compare successive more expensive interventions to the previous less expensive one. One-way sensitivity analyses were conducted to test the robustness of the model's outputs. At the Namibian cost/DALY averted threshold of US$3 142, the (1) BD vaccination + targeted HBIG, and (2) maternal antiviral prophylaxis with sequential HBeAg testing interventions were cost-effective. These interventions had ICERs equal to US$1909.03/DALY and US$2598.90/DALY averted, respectively. In terms of effectiveness, the maternal antiviral prophylaxis with sequential HBeAg testing intervention was the intervention of choice. The analysis showed that elimination of HBV MTCT is achievable using maternal antiviral prophylaxis with active and passive immunization. There is an urgent need for low cost diagnostic tests to identify those women who will most benefit from drug therapy to attain this laudable goal.
