Modelling cost-effectiveness of tenofovir for prevention of mother to child transmission of hepatitis B virus (HBV) infection in South Africa

BMC Public Health

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[1] 0000 0001 2214 904X, grid.11956.3a, Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, 8000, Tygerberg, Cape Town, Republic of South Africa;0000 0001 2214 904X, grid.11956.3a, Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, 8000, Tygerberg, Cape Town, Republic of South Africa;0000 0001 2306 7492, grid.8348.7, Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, OX3 9DU, Oxford, UK;0000 0001 2284 638X, grid.412219.d, Division of Virology, University of the Free State/National Health Laboratory Service, PO Box 339(G23), 9300, Bloemfontein, Republic of South Africa;0000 0004 1936 8948, grid.4991.5, Centre for Statistics in Medicine, University of Oxford, OX3 7LD, Oxford, UK;0000 0004 1936 8948, grid.4991.5, Nuffield Department of Medicine, Medawar Building, South Parks Road, OX1 3SY, Oxford, UK;0000 0004 1936 8948, grid.4991.5, Nuffield Department of Medicine, Medawar Building, South Parks Road, OX1 3SY, Oxford, UK;0000 0001 2306 7492, grid.8348.7, Department of Hepatology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, OX3 9DU, Oxford, UK;0000 0001 2306 7492, grid.8348.7, National Institute of Health Research, Oxford Biomedical Research Centre, John Radcliffe Hospital, Headley Way, Headington, OX3 9DU, Oxford, UK;0000 0004 1936 8948, grid.4991.5, Nuffield Department of Medicine, Medawar Building, South Parks Road, OX1 3SY, Oxford, UK;0000 0001 2306 7492, grid.8348.7, National Institute of Health Research, Oxford Biomedical Research Centre, John Radcliffe Hospital, Headley Way, Headington, OX3 9DU, Oxford, UK;0000 0001 2306 7492, grid.8348.7, Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, OX3 9DU, Oxford, UK;

关键词: Tenofovir;    Hepatitis B;    HBV;    PMTCT;    Elimination;    Transmission;    Epidemiology;    Africa;   

DOI  :  10.1186/s12889-019-7095-4

来源: publisher

【 摘 要 】

BackgroundInternational sustainable development goals for the elimination of viral hepatitis as a public health problem by 2030 highlight the need to optimize strategies for prevention, diagnosis and treatment of hepatitis B virus (HBV) infection. An important priority for Africa is to have affordable, accessible and sustainable prevention of mother to child transmission (PMTCT) programmes, delivering screening and treatment for antenatal women and implementing timely administration of HBV vaccine for their babies.MethodsWe developed a decision-analytic model simulating 10,000 singleton pregnancies to assess the cost-effectiveness of three possible strategies for deployment of tenofovir in pregnancy, in combination with routine infant vaccination: S1: no screening nor antiviral therapy; S2: screening and antiviral prophylaxis for all women who test HBsAg-positive; S3: screening for HBsAg, followed by HBeAg testing and antiviral prophylaxis for women who are HBsAg-positive and HBeAg-positive. Our outcome was cost per infant HBV infection avoided and the analysis followed a healthcare perspective.ResultsBased on 10,000 pregnancies, S1 predicts 45 infants would be HBV-infected at six months of age, compared to 21 and 28 infants in S2 and S3, respectively. Relative to S1, S2 had an incremental cost of $3940 per infection avoided. S3 led to more infections and higher costs.ConclusionGiven the long-term health burden for individuals and economic burden for society associated with chronic HBV infection, screening pregnant women and providing tenofovir for all who test HBsAg+ may be a cost-effective strategy for South Africa and other low/middle income settings.

【 授权许可】

CC BY