Modelling cost-effectiveness of tenofovir for prevention of mother to child transmission of hepatitis B virus (HBV) infection in South Africa
Date
2019-06-26
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
Background: International 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.
Methods: We developed a decision-analytic model simulating 10,000 singleton pregnancies to assess the costeffectiveness
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.
Results: Based 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.
Conclusion: Given 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 costeffective
strategy for South Africa and other low/middle income settings.
Description
CITATION: Mokaya, J., et al. 2019. Modelling cost-effectiveness of tenofovir for prevention of mother to child transmission of hepatitis B virus (HBV) infection in South Africa. BMC Public Health, 19:829, doi:10.1186/s12889-019-7095-4.
The original publication is available at https://bmcpublichealth.biomedcentral.com
The original publication is available at https://bmcpublichealth.biomedcentral.com
Keywords
Tenofovir, Hepatitis B virus -- Disease transmission, Pregnant women, Prenatal care
Citation
Mokaya, J., et al. 2019. Modelling cost-effectiveness of tenofovir for prevention of mother to child transmission of hepatitis B virus (HBV) infection in South Africa. BMC Public Health, 19:829, doi:10.1186/s12889-019-7095-4