Juan Yin
Xi’an Jiaotong University, China
Title: Cost-effectiveness of maternal antiviral treatment for further preventing mother-to-infant hepatitis B virus transmission in China
Biography
Biography: Juan Yin
Abstract
Objective: About 10−20% of infants born to HBsAg and HBeAg positive mothers with high viral loads still incur perinatal transmission of HBV though received active-passive immunoprophylaxis. Three nucleoside drugs (lamivudine, telbivudine and tenofovir) have demonstrated effect in decreasing maternal serum HBV-DNA level and diminishing the risk of perinatal transmission by many clinical trials. This study aimed at evaluating the cost-effectiveness of prophylactic use of antiviral therapies in HBsAg and HBeAg positive mothers for further preventing mother-to-child HBV transmission and identifying which one of the three antiviral agents was the most cost-effective.
Materials & Method: A decision-Markov model from a societal perspective was constructed to investigate the cost-effectiveness of four different strategies: lamivudine, telbivudine, tenofovir treatment strategy, and the current active-passive immunoprophylaxis. Clinical outcomes and cost were calculated for each strategy. The incremental cost-effectiveness ratio was calculated. One-way and probabilistic sensitivity analyses were used to explore the parameters’ impact on the uncertainty of the results.
Results: For the simulated 100000 newborns, lamivudine, telbivudine and tenofovir strategies could diminish HBV-related liver diseases and save 3747, 6988 and 9114 QALYs, respectively, compared with the active-passive immunoprophylaxis strategy. Under the baseline assumptions, the incremental cost-effectiveness ratio (ICER) of lamivudine, telbivudine and tenofovir strategies compared with the active-passive immunoprophylaxis strategy were 31733, 24516 and 40070, respectively. Strategy telbivudine had an of 16170 CN$ per quality-adjusted life year (QALY) gained compared with strategy lamivudine, whilst strategy tenofovir had an ICER of 91178 CN$ per QALY gained compared with strategy telbivudine.
Conclusion: According to WHO’s criteria, antiviral treatments with lamivudine, telbivudine and tenofovir for mothers who were positive for HBsAg and HBeAg in late trimester were all highly cost-effective when compared with the current active-passive immunoprophylaxis. Telbivudine was the most cost-effective strategy when the willingness-to-pay was between one and three times per-capita GDP per QALY gained (CN$ 41908-125724).