Nguyen Ha T, Chaikledkaew Usa, Hoang Minh V, Tran Viet Q, Thavorncharoensap Montarat, Praditsitthikorn Naiyana, Tran Quang D, Thakkinstian Ammarin
Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, 10400, Thailand.
University of Health Sciences, Vietnam National University Ho Chi Minh City, Binh Duong City, 820000, Vietnam.
BMC Health Serv Res. 2024 Dec 28;24(1):1658. doi: 10.1186/s12913-024-12152-z.
No cost-effectiveness information of preventive strategies for mother-to-child transmission (MTCT) of hepatitis B virus (HBV) has existed for policy decision making. This study aimed to compare the cost-effectiveness of alternative strategies to prevent MTCT of HBV in Vietnam. Cost-utility analysis using a hybrid decision-tree and Markov model were performed from healthcare system and societal perspectives. Preventive strategies included HBV universal vaccination (S1), hepatitis B immunoglobulin (HBIG) for infants of mothers with HBeAg( +) (S2), HBIG for infants of mothers with HBsAg( +) (S3), tenofovir disoproxil fumarate (TDF) for mothers with high viral load (S4) and mothers with HBeAg( +) (S5), and the current practice (S6) with HBV vaccine in all infants and TDF for high viral load mothers. The current practice was dominant to all preventive strategies with interventions in only infants for both perspectives. In contrast, the strategies S4 and S5 were dominant to the current practice with incremental net monetary benefit varying from $33.94 to $70.64 under a healthcare system perspective and from $44.22 to $93.71 under a societal perspective. Addition of HBIG in infants born to mothers infected HBV and tenofovir prophylaxis for mothers with positive HBeAg was the most cost-effective strategy to prevent vertical transmission of HBV in Vietnam.
目前尚无关于乙型肝炎病毒（HBV）母婴传播（MTCT）预防策略的成本效益信息以供决策。本研究旨在比较越南预防HBV母婴传播的替代策略的成本效益。从医疗保健系统和社会角度，使用混合决策树和马尔可夫模型进行了成本效用分析。预防策略包括HBV普遍接种（S1）、对HBeAg(+)母亲所生婴儿使用乙型肝炎免疫球蛋白（HBIG）（S2）、对HBsAg(+)母亲所生婴儿使用HBIG（S3）、对高病毒载量母亲使用替诺福韦酯（TDF）（S4）以及对HBeAg(+)母亲使用TDF（S5），以及当前的做法（S6），即对所有婴儿接种HBV疫苗并对高病毒载量母亲使用TDF。从两个角度来看，当前的做法对所有仅干预婴儿的预防策略都具有优势。相比之下，S4和S5策略相对于当前做法具有优势，在医疗保健系统角度下增量净货币效益从33.94美元到70.64美元不等，在社会角度下从44.22美元到93.71美元不等。在越南，对感染HBV母亲所生婴儿添加HBIG以及对HBeAg阳性母亲进行替诺福韦预防是预防HBV垂直传播最具成本效益的策略。
