Cost-effectiveness of prenatal screening and immunization for hepatitis B virus
J. A. Arevalo and A. E. Washington
Department of Family Practice, University of California at Davis, Sacramento 95817.
Perinatal transmission of hepatitis B virus is associated with substantial
morbidity and mortality, yet controversy still exists regarding the value
of routine screening of pregnant women in the United States and subsequent
immunization of their at-risk neonates. To evaluate the cost-effectiveness
of such a screening and immunization program, we developed a decision
analysis model and obtained data from published reports, chart review, and
a Delphi survey to determine outcome probabilities and costs. When
considering direct and indirect costs, routine screening and immunization
would be cost-effective at a prevalence of 0.06%, significantly lower than
the national prevalence of 0.2%. At an annual national birth rate of 3.5
million births, a national policy of routine screening of all pregnant
women would result in an annual net savings of more than $105 million. In
the high-risk groups, as many as 140 cases of acute neonatal hepatitis and
as many as 1400 cases of chronic liver disease would be prevented yearly
per 100,000 pregnant women screened, at a net annual savings of as much as
$765 million.
