Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
Laboratoire Mixte International de Vaccinologie (LAMIVAC), Bobo-Dioulasso, Burkina Faso.
Int J Gynaecol Obstet. 2024 Jul;166(1):44-61. doi: 10.1002/ijgo.15515. Epub 2024 Apr 3.
Economic feasibility of eliminating mother-to-child transmission (MTCT) of hepatitis B virus (HBV) in highly endemic African countries remains uncertain. Prevention of MTCT (PMTCT) involves screening pregnant women for hepatitis B surface antigen (HBsAg), identifying those with high viral loads or hepatitis B e antigen (HBeAg), and administering tenofovir prophylaxis to high-risk women. We estimated the costs of integrating PMTCT services into antenatal care in Burkina Faso, based on four different strategies to select women for tenofovir prophylaxis: (1) HBV DNA (≥200 000 IU/mL), (2) HBeAg, (3) hepatitis B core-related antigen rapid diagnostic test (HBcrAg-RDT) and (4) all HBsAg-positive women.
Using a micro-costing approach, we estimated the incremental economic cost of integrating each strategy into routine antenatal care in 2024, compared to neonatal vaccination alone. Sensitivity analyses explored variations in prevalence, service coverage, test and tenofovir prices.
HBcrAg-RDT strategy was the least expensive, with a total economic cost of US$3959689, compared to HBV DNA (US$6128875), HBeAg (US$4135233), and treat-all (US$4141206). The cost per pregnant woman receiving tenofovir prophylaxis varied from US$61.88 (Treat-all) to US$1071.05 (HBV DNA). The Treat-All strategy had the lowest marginal cost due to a higher number of women on tenofovir (66928) compared to HBV DNA (5722), HBeAg (10020), and HBcrAg-RDT (7234). In sensitivity analyses, the treat-all strategy became less expensive when the tenofovir price decreased.
HBcrAg-RDT minimizes resource use and costs, representing 0.61% of Burkina Faso's 2022 health budget. This study highlights the potential economic feasibility of these strategies and provides valuable resources for conducting cost-effectiveness analyses.
在乙型肝炎病毒（HBV）高度流行的非洲国家，消除母婴传播（MTCT）的经济可行性仍不确定。预防 MTCT（PMTCT）包括对孕妇进行乙型肝炎表面抗原（HBsAg）筛查，确定高病毒载量或乙型肝炎 e 抗原（HBeAg）的患者，并对高危妇女进行替诺福韦预防。我们根据四种不同的替诺福韦预防方案来选择妇女：（1）HBV DNA（≥200000 IU/mL），（2）HBeAg，（3）乙型肝炎核心相关抗原快速诊断检测（HBcrAg-RDT）和（4）所有 HBsAg 阳性妇女，估计在布基纳法索将 PMTCT 服务纳入产前保健的成本。
使用微观成本法，我们估计了 2024 年将每种策略纳入常规产前保健的增量经济成本，与单独进行新生儿疫苗接种相比。敏感性分析探讨了流行率、服务覆盖范围、检测和替诺福韦价格的变化。
HBcrAg-RDT 策略的总成本最低，为 3959689 美元，而 HBV DNA（6128875 美元）、HBeAg（4135233 美元）和“所有治疗”（4141206 美元）的总成本最高。接受替诺福韦预防的孕妇的人均成本从“所有治疗”（61.88 美元）到 HBV DNA（1071.05 美元）不等。由于接受替诺福韦治疗的妇女数量（66928 人）高于 HBV DNA（5722 人）、HBeAg（10020 人）和 HBcrAg-RDT（7234 人），因此“所有治疗”策略的边际成本最低。在敏感性分析中，当替诺福韦价格下降时，“所有治疗”策略变得更便宜。
HBcrAg-RDT 最大限度地减少了资源的使用和成本，占布基纳法索 2022 年卫生预算的 0.61%。本研究强调了这些策略的潜在经济可行性，并为进行成本效益分析提供了有价值的资源。
