Pediatrics
March 2013, VOLUME 131 / ISSUE 3
http://pediatrics.aappublications.org/current.shtml
[Reviewed earlier; No relevant content]

Early Release
Article
Cost-effectiveness of Augmenting Universal Hepatitis B Vaccination With Immunoglobin Treatment
Solomon Chih-Cheng Chen, MD, PhDa,b, Mehlika Toy, DrPH, PhDa,c, Jennifer M. Yeh, PhDd,
Jung-Der Wang, MD, ScDe, and Stephen Resch, MPH, PhDd
http://pediatrics.aappublications.org/content/early/2013/03/18/peds.2012-1262.abstract

Abstract
OBJECTIVE: To compare the cost-effectiveness of hepatitis B virus (HBV) control strategies combining universal vaccination with hepatitis B immunoglobulin (HBIG) treatment for neonates of carrier mothers.

METHODS: Drawing on Taiwan’s experience, we developed a decision-analytic model to estimate the clinical and economic outcomes for 4 strategies: (1) strategy V—universal vaccination; (2) strategy S—V plus screening for hepatitis B surface antigen (HBsAg) and HBIG treatment for HBsAg-positive mothers’ neonates; (3) strategy E—V plus screening for hepatitis B e-antigen (HBeAg), HBIG for HBeAg-positive mothers’ neonates; (4) strategy S&E—V plus screening for HBsAg then HBeAg, HBIG for all HBeAg-positive, and some HBeAg-negative/HBsAg-positive mothers’ neonates.

RESULTS: Strategy S averted the most infections, followed by S&E, E, and V. In most cases, the more effective strategies were also more costly. The willingness-to-pay (WTP) above which strategy S was cost-effective rose as carrier rate declined and was <$4000 per infection averted for carrier rates >5%. The WTP below which strategy V was optimal also increased as carrier rate declined, from $1400 at 30% carrier rate to $3100 at 5% carrier rate. Strategies involving E were optimal for an intermediate range of WTP that narrowed as carrier rate declined.

CONCLUSIONS: HBIG treatment for neonates of HBsAg carrier mothers is likely to be a cost-effective addition to universal vaccination, particularly in settings with adequate health care infrastructure. Targeting HBIG to neonates of higher risk HBeAg-positive mothers may be preferred where WTP is moderate. However, in very resource-limited settings, universal vaccination alone is optimal.