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Cost-effectiveness of antiviral prophylaxis during pregnancy for the prevention of perinatal hepatitis B infection in South Korea

Cited 12 time in Web of Science Cited 13 time in Scopus
Authors
Lee, Donghoon; Shin, Hyun-Young; Park, Sang Min
Issue Date
2018-02-15
Publisher
BioMed Central
Citation
Cost Effectiveness and Resource Allocation, 16(1):6
Keywords
Hepatitis BPerinatal infectionAntiviral prophylaxisCost-effectiveness analysis
Abstract
Background
In Korea, hepatitis B virus (HBV) infection accounts for approximately 65–75% of HBV-related diseases, such as chronic hepatitis and liver cancer, and mother-to-child transmission is presumed to be a major source of the infection. To tackle this issue, the Korean government launched the national Perinatal Hepatitis B Prevention Program (PHBPP) in 2002. This study analyzed the cost-effectiveness of the PHBPP with antiviral prophylaxis compared with the current PHBPP and/or universal vaccination, as well as identified the optimal strategy to eliminate mother-to-child transmission of HBV in Korea.

Methods
A decision tree model with the Markov process was developed and simulated over the lifetime of a birth cohort in Korea during the year 2014. The current PHBPP providing HBV vaccine and hepatitis B immune globulin to neonates born to HBV positive mothers was compared against two other strategies, universal vaccination of HBV and PHBPP with antiviral prophylaxis, with respect to their costs and health outcomes. The Korean National Health Insurance database was investigated to estimate the costs of HBV-related diseases and utilization of health resources. Costs were assessed from the health care system perspective and converted to 2014 US dollars. Health outcome measures were quality-adjusted life years (QALYs) and number of HBV-related diseases and deaths. Both costs and QALYs were discounted at 5%, following the recommendation of the Health Insurance Review & Assessment Service in Korea. The incremental cost-effectiveness ratio (ICER) obtained from the analysis was evaluated using the willingness-to-pay (WTP) in the Korean society.

Results
PHBPP with antiviral prophylaxis in Korea was cost-effective compared with the current PHBPP. An introduction of antiviral prophylaxis to pregnant women with a high viral load of HBV averted 13 HBV-related deaths per 100,000 people and saved 82 QALYs in total (ICER: $16,159/QALY).

Conclusions
Considering that WTP in Korea is $29,000, PHBPP with antiviral prophylaxis appears to be a cost-effective strategy. To further decrease the burden of perinatal hepatitis B in Korea, adding antiviral prophylaxis to PHBPP is recommended.
ISSN
1478-7547
Language
English
URI
https://hdl.handle.net/10371/139586
DOI
https://doi.org/10.1186/s12962-018-0088-9
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College of Medicine/School of Medicine (의과대학/대학원)Family Medicine (가정의학전공)Journal Papers (저널논문_가정의학전공)
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