TY - JOUR
T1 - Tenofovir disoproxil fumarate in pregnancy for prevention of mother to child transmission of hepatitis B in a rural setting on the Thailand-Myanmar border
T2 - a cost-effectiveness analysis
AU - Bierhoff, Marieke
AU - Angkurawaranon, Chaisiri
AU - Rijken, Marcus J
AU - Sriprawa, Kanlaya
AU - Kobphan, Pachinee
AU - Nosten, Francois N
AU - van Vugt, Michèle
AU - McGready, Rose
AU - Devine, Angela
N1 - Funding Information:
Shoklo Malaria Research Unit (SMRU) provides humanitarian health care for marginalized populations on the border of Thailand and Myanmar. At the time of data collection, antenatal care and delivery services were available at two migrant sites, Mawker Thai (MKT) and Wang-Pha (WPA), and one refugee site, Maela (MLA) camp. Attendance at these clinics is free. Public health programmes, including childhood vaccinations, supported in part by the Thailand Department of Public Health. Thai guidelines recommend HBIG for all HBsAg positive patients, but unless payment can be guaranteed this is not provided to non-Thai mothers. SMRU has not had funding available for HBIG since 2016.
Funding Information:
The work is supported by the Wellcome-Trust Major Overseas Program in Southeast Asia [grant number: 106698/Z/14/Z] to Mahidol University Oxford Tropical Medicine Research Programme which directly supports FN and RM from Shoklo Malaria Research Unit. The funding body had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/2/22
Y1 - 2021/2/22
N2 - BACKGROUND: Hepatitis 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.METHODS: The 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.RESULTS: Vaccine only was the least costly option with TDF after HBeAg test strategy as the only cost-effective alternative. TDF after HBeAg test had 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 that TDF after HBeAg test had an 84% likelihood of being cost effective at a willingness to pay threshold of one GDP per capita per infection averted.CONCLUSIONS: We found that TDF after HBeAg test has 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. While TDF after RDT may be a more feasible strategy to implement in RLS, TDF after HBeAg test is a less costly option.
AB - BACKGROUND: Hepatitis 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.METHODS: The 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.RESULTS: Vaccine only was the least costly option with TDF after HBeAg test strategy as the only cost-effective alternative. TDF after HBeAg test had 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 that TDF after HBeAg test had an 84% likelihood of being cost effective at a willingness to pay threshold of one GDP per capita per infection averted.CONCLUSIONS: We found that TDF after HBeAg test has 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. While TDF after RDT may be a more feasible strategy to implement in RLS, TDF after HBeAg test is a less costly option.
KW - Adult
KW - Antiviral Agents/therapeutic use
KW - Cost-Benefit Analysis
KW - Female
KW - Hepatitis B/prevention & control
KW - Humans
KW - Infectious Disease Transmission, Vertical/prevention & control
KW - Myanmar
KW - Pregnancy
KW - Pregnancy Complications, Infectious/virology
KW - Reproducibility of Results
KW - Rural Population
KW - Tenofovir/therapeutic use
KW - Thailand
KW - Viral Load
KW - Young Adult
KW - Cost-effectiveness
KW - Perinatal infection
KW - Antiviral therapy
UR - http://www.scopus.com/inward/record.url?scp=85101307796&partnerID=8YFLogxK
U2 - 10.1186/s12884-021-03612-z
DO - 10.1186/s12884-021-03612-z
M3 - Article
C2 - 33618698
SN - 1471-2393
VL - 21
SP - 1
EP - 12
JO - BMC Pregnancy and Childbirth
JF - BMC Pregnancy and Childbirth
IS - 1
M1 - 157
ER -