扩大妊娠期的抗病毒预防，以预防围产期乙型肝炎病毒感染

StephenW

Expanding Antiviral Prophylaxis During Pregnancy to Prevent Perinatal Hepatitis B Virus Infection: A Cost-effectiveness Study
Jiangyang Du  1 , Zhenhua Wang  2 , Bin Wu  1
Affiliations
Affiliations

    1
    Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
    2
    Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.

    PMID: 32478119 PMCID: PMC7246348 DOI: 10.1093/ofid/ofaa137

Abstract

Background: Mother-to-child transmission (MTCT) cannot be completely prevented by the administration of active-passive immunoprophylaxis in pregnant women with hepatitis B virus (HBV) DNA levels <106 copies/mL. This study will assess the economic outcomes of expanding antiviral prophylaxis in pregnant women with HBV DNA levels <106 copies/mL.

Methods: A decision model was adopted to measure the economic outcomes of expanded antiviral prophylaxis at different cutoff values of HBV DNA in HBsAg(+) pregnant women in the context of the United States and China. The model inputs, including clinical, cost, and utility data, were extracted from published studies. Sensitivity analyses were carried out to examine the uncertainty of the model outputs. Quality-adjusted life-years (QALYs) and direct medical costs were expressed over a lifetime horizon.

Results: Compared with standard antiviral prophylaxis at HBV DNA ≥106 copies/mL, expanded antiviral prophylaxis improved the health outcomes, and the incremental cost of expanded antiviral prophylaxis varied from $2063 in pregnant women with HBV DNA ≥105 copies/mL to $14 925 in all HBsAg(+) pregnant women per QALY gained in the United States, and from $1624 to $12 348 in China. The model outcome was considerably influenced by the discount rate, key clinical parameters related to the incidence of MTCT, and efficacy of the prophylaxis strategy.

Conclusions: This study indicates that antiviral prophylaxis using tenofovir among pregnant women with HBV DNA <106 copies/mL may be a cost-effective option, and the cutoff value of the HBV DNA load for antiviral prophylaxis needs to be tailored.

Keywords: antiviral prophylaxis; cost-effectiveness; hepatitis B virus; mother-to-child transmission.

© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

StephenW

扩大妊娠期的抗病毒预防，以预防围产期乙型肝炎病毒感染：一项成本效益研究
杜江阳1，王振华2，吴斌1
隶属关系
隶属关系

    1个
    上海交通大学医学院南校区仁济医院药剂科医疗决策与经济小组，上海
    2
    上海交通大学医学院附属仁济医院消化内科，上海

    PMID：32478119 PMCID：PMC7246348 DOI：10.1093 / ofid / ofaa137

抽象

背景：对乙型肝炎病毒（HBV）DNA水平<106拷贝/ mL的孕妇进行主动-被动免疫预防不能完全预防母婴传播（MTCT）。这项研究将评估在HBV DNA水平<106拷贝/ mL的孕妇中扩大抗病毒药物预防的经济效果。

方法：在美国和中国的背景下，采用决策模型来衡量在不同的HBsAg（+）孕妇HBV DNA临界值下，扩大抗病毒药物预防的经济效果。从已发表的研究中提取了模型输入，包括临床，成本和效用数据。进行了敏感性分析，以检查模型输出的不确定性。质量调整生命年（QALYs）和直接医疗费用以生命周期为单位表示。

结果：与标准抗病毒预防措施（HBV DNA≥106拷贝/ mL）相比，扩大抗病毒预防措施可改善健康状况，扩大抗病毒预防措施的增加成本从HBV DNA≥105拷贝/ mL的孕妇$ 2063至$ 14 925。在美国，每个QALY中所有HBsAg（+）孕妇的人数都从1624美元增加到了12348美元，在中国达到了12348美元。模型的结果很大程度上受到折现率，与MTCT发生率相关的关键临床参数以及预防策略的有效性的影响。

结论：这项研究表明，替诺福韦在HBV DNA <106拷贝/ mL的孕妇中进行抗病毒预防可能是一种经济有效的选择，并且需要调整HBV DNA负荷对抗病毒预防的临界值。

关键词：预防病毒；成本效益;乙型肝炎病毒;母婴传播。

©作者2020。由牛津大学出版社代表美国传染病学会出版

StephenW

https://academic.oup.com/ofid/ad ... 3107603/ofaa137.pdf