Negasa Abdi Gari, Bobo Firew Tekle, Falta Desalegn Feleke, Chala Temesgen Kabeta, Bayou Negalign Berhanu
Department of Health Policy and Management, Collage of Health and Medical Science, Haramaya University, Harar, Ethiopia.
Fenot Associates, Addis Ababa, Ethiopia.
BMC Public Health. 2025 Apr 7;25(1):1300. doi: 10.1186/s12889-025-22498-6.
Perinatal transmission of hepatitis B virus (HBV) remains a significant public health issue. To complement vaccination, tenofovir disoproxil fumarate (TDF) prophylaxis is recommended for HBV-infected pregnant women. We aimed to identify a cost-effective strategy for using TDF to prevent perinatal HBV transmission in Ethiopia.
A decision tree combined with a Markov model was used to determine the cost-effectiveness of different strategies for preventing perinatal transmission of HBV in a cohort of 10,000 hepatitis B surface antigen (HBsAg)-positive pregnant women. The existing vaccination strategy (Strategy 1) was compared with three alternative strategies that added TDF prophylaxis to the existing strategy. Strategy 2 (TDF prophylaxis following HBV viral load testing), Strategy 3 (TDF prophylaxis following hepatitis B envelope antigen (HBeAg) testing), and Strategy 4 (TDF prophylaxis for all HBsAg-positive). Costs were measured from the healthcare sector perspective. Effects were measured as HBV infection averted and disability adjusted life years (DALYs) averted. Model input parameters were obtained from the literature review and local data. Cost-effectiveness was determined by the incremental cost-effectiveness ratio (ICER), with thresholds set at 0.34, 1, and 3 times the GDP per capita of Ethiopia. A sensitivity analysis was conducted to test the robustness of the results.
Among the alternatives, Strategy 4 is the most cost-effective strategy, with an ICER of 220.3 US$ per DALY averted. Strategy 4 would prevent 267 perinatal HBV infections and averted 1048 DALYs per 10,000 HBsAg-positive pregnant women. These results were robust to a range of parameters and showed a 97% probability of being cost-effective at one times the GDP per capita of Ethiopia. The next optimal strategy is Strategy 2, compared with the next best alternative, with an ICER of 1175.52 US$ per DALY averted. Strategy 3 was dominated by the available strategies.
Providing TDF prophylaxis for all HBsAg-positive pregnant women starting at 28 weeks of pregnancy has the potential to be a cost-effective strategy in Ethiopia. Introduction of TDF prophylaxis for all HBsAg-positive pregnant women is highly recommended, along with efforts to improve vaccination coverage.
乙型肝炎病毒（HBV）的围产期传播仍然是一个重大的公共卫生问题。为补充疫苗接种，建议对感染HBV的孕妇使用替诺福韦酯（TDF）进行预防。我们旨在确定一种在埃塞俄比亚使用TDF预防围产期HBV传播的具有成本效益的策略。
采用决策树结合马尔可夫模型来确定在10000名乙型肝炎表面抗原（HBsAg）阳性孕妇队列中预防HBV围产期传播的不同策略的成本效益。将现有的疫苗接种策略（策略1）与三种替代策略进行比较，这三种替代策略是在现有策略基础上增加TDF预防措施。策略2（HBV病毒载量检测后进行TDF预防）、策略3（乙型肝炎e抗原（HBeAg）检测后进行TDF预防）和策略4（对所有HBsAg阳性者进行TDF预防）。成本从医疗保健部门的角度进行衡量。效果以避免的HBV感染和避免的伤残调整生命年（DALYs）来衡量。模型输入参数来自文献综述和当地数据。成本效益通过增量成本效益比（ICER）来确定，阈值设定为埃塞俄比亚人均国内生产总值的0.34倍、1倍和3倍。进行敏感性分析以检验结果的稳健性。
在这些替代策略中，策略4是最具成本效益的策略，ICER为每避免一个DALY 220.3美元。每10000名HBsAg阳性孕妇中，策略4可预防267例围产期HBV感染并避免1048个DALYs。这些结果在一系列参数范围内是稳健的，并且在埃塞俄比亚人均国内生产总值1倍的情况下具有成本效益的概率为97%。次优策略是策略2，与次佳替代策略相比，ICER为每避免一个DALY 1175.52美元。策略3被现有策略所主导。
从妊娠28周开始为所有HBsAg阳性孕妇提供TDF预防措施在埃塞俄比亚有可能成为一种具有成本效益的策略。强烈建议为所有HBsAg阳性孕妇引入TDF预防措施，并努力提高疫苗接种覆盖率。
