Purpose: Lamivudine treatment in the third trimester is effective in further decreasing perinatal transmission in viremic hepatitis B-infected pregnant women. This study investigates the cost-efficacy of lamivudine therapy in this setting.
Method: A decision analytic model was designed to compare lamivudine treated versus untreated hepatitis B-infected pregnant women who demonstrated significant viremia in the third trimester. Baseline assumptions included 80% of women in treatment arm with significant viral load decrease, 15% perinatal transmission in viremic women despite infant immunoprophylaxis, 50% overall reduction of perinatal transmission in those women treated with lamivudine who achieved viral load decreases at time of delivery, 85% development of chronic hepatitis B in perinatally infected infants, and $24,000 lifetime cost for chronic hepatitis B condition. Univariate sensitivity analysis was performed to test for robustness.
Result: Lamivudine therapy for viremic pregnant women is cost effective, resulting in dominant (lower cost, better outcomes) strategy. The cost of lamivudine, including long-term healthcare cost of chronically infected neonates, is $2,309 per person, while the cost of no therapy with lamivudine is $2,822 per person. Treatment with lamivudine resulted in an increase of 0.14 discounted life years per person. Use of lamivudine is cost-effective over a wide range of assumptions. Eighteen women with high hepatitis B viral load need to be treated with lamivudine, in addition to infant immunoprophylaxis, to prevent one hepatitis B affected infant.
Conclusion: Treatment of viremic hepatitis B-infected women with lamivudine to prevent vertical transmission and subsequent development of chronic hepatitis B in the infected infants is cost-effective over a wide range of assumptions.
Candidate for the Lee B. Lusted Student Prize Competition