Antenatal lamivudine to reduce perinatal hepatitis B transmission: A cost-effectiveness analysis

Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
American journal of obstetrics and gynecology (Impact Factor: 4.7). 09/2012; 207(3):231.e1-7. DOI: 10.1016/j.ajog.2012.06.001
Source: PubMed


This study aimed to determine whether administration of lamivudine to pregnant women with chronic hepatitis B in the third trimester is a cost-effective strategy in preventing perinatal transmission.
We developed a decision analysis model to compare the cost-effectiveness of 2 management strategies for chronic hepatitis B in pregnancy: (1) expectant management or (2) lamivudine administration in the third trimester. We assumed that lamivudine reduced perinatal transmission by 62%.
Our Markov model demonstrated that lamivudine administration is the dominant strategy. For every 1000 infected pregnant women treated with lamivudine, $337,000 is saved and 314 quality-adjusted life-years are gained. For every 1000 pregnancies with maternal hepatitis B, lamivudine prevents 21 cases of hepatocellular carcinoma and 5 liver transplants in the offspring. The model remained robust in sensitivity analysis.
Antenatal lamivudine administration to pregnant patients with hepatitis B is cost-effective, and frequently cost-saving, under a wide range of circumstances.

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    • "A limitation of our study is that there is now data to support the use of lamivudine in pregnancy to reduce viral load and thereby limit perinatal transmission [5]. Treatment with lamivudine was not standard of care at our institutions for the cases analyzed from 2005–2009 and has only been adopted more recently. "
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