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Jose Alberto Arevalo, MD; A. Eugene Washington, MD, MSc

JAMA. 1988;259(3):365-369.

Abstract
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.

(JAMA 1988;259:365-369)

Author Affiliations
From the Department of Family Practice, University of California at Davis, Sacramento (Dr Arevalo); the Division of Family and Community Medicine (Dr Arevalo) and the Clinical Epidemiology Program, Institute for Health Policy Studies (Dr Washington), University of California School of Medicine, San Francisco; and the Department of Gynecology and Obstetrics, Stanford (Calif) University School of Medicine (Dr Washington).

Footnotes
Reprint requests to Department of Family Practice, University of California at Davis, Medical Center, 2221 Stockton Blvd, Sacramento, CA 95817 (Dr Arevalo).

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