PMID- 31242901 OWN - NLM STAT- MEDLINE DCOM- 20190903 LR - 20231012 IS - 1471-2458 (Electronic) IS - 1471-2458 (Linking) VI - 19 IP - 1 DP - 2019 Jun 26 TI - Modelling cost-effectiveness of tenofovir for prevention of mother to child transmission of hepatitis B virus (HBV) infection in South Africa. PG - 829 LID - 10.1186/s12889-019-7095-4 [doi] LID - 829 AB - BACKGROUND: International sustainable development goals for the elimination of viral hepatitis as a public health problem by 2030 highlight the need to optimize strategies for prevention, diagnosis and treatment of hepatitis B virus (HBV) infection. An important priority for Africa is to have affordable, accessible and sustainable prevention of mother to child transmission (PMTCT) programmes, delivering screening and treatment for antenatal women and implementing timely administration of HBV vaccine for their babies. METHODS: We developed a decision-analytic model simulating 10,000 singleton pregnancies to assess the cost-effectiveness of three possible strategies for deployment of tenofovir in pregnancy, in combination with routine infant vaccination: S1: no screening nor antiviral therapy; S2: screening and antiviral prophylaxis for all women who test HBsAg-positive; S3: screening for HBsAg, followed by HBeAg testing and antiviral prophylaxis for women who are HBsAg-positive and HBeAg-positive. Our outcome was cost per infant HBV infection avoided and the analysis followed a healthcare perspective. RESULTS: Based on 10,000 pregnancies, S1 predicts 45 infants would be HBV-infected at six months of age, compared to 21 and 28 infants in S2 and S3, respectively. Relative to S1, S2 had an incremental cost of $3940 per infection avoided. S3 led to more infections and higher costs. CONCLUSION: Given the long-term health burden for individuals and economic burden for society associated with chronic HBV infection, screening pregnant women and providing tenofovir for all who test HBsAg+ may be a cost-effective strategy for South Africa and other low/middle income settings. FAU - Mokaya, Jolynne AU - Mokaya J AD - Nuffield Department of Medicine, Medawar Building, South Parks Road, Oxford, OX1 3SY, UK. FAU - Burn, Edward A O AU - Burn EAO AD - Centre for Statistics in Medicine, University of Oxford, Oxford, OX3 7LD, UK. FAU - Tamandjou, Cynthia Raissa AU - Tamandjou CR AD - Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 8000, Cape Town, Republic of South Africa. FAU - Goedhals, Dominique AU - Goedhals D AD - Division of Virology, University of the Free State/National Health Laboratory Service, PO Box 339(G23), Bloemfontein, 9300, Republic of South Africa. FAU - Barnes, Eleanor J AU - Barnes EJ AD - Nuffield Department of Medicine, Medawar Building, South Parks Road, Oxford, OX1 3SY, UK. AD - Department of Hepatology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK. AD - National Institute of Health Research, Oxford Biomedical Research Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK. FAU - Andersson, Monique AU - Andersson M AD - Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 8000, Cape Town, Republic of South Africa. AD - Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK. FAU - Pinedo-Villanueva, Rafael AU - Pinedo-Villanueva R AD - Centre for Statistics in Medicine, University of Oxford, Oxford, OX3 7LD, UK. FAU - Matthews, Philippa C AU - Matthews PC AUID- ORCID: 0000-0002-4036-4269 AD - Nuffield Department of Medicine, Medawar Building, South Parks Road, Oxford, OX1 3SY, UK. philippa.matthews@ndm.ox.ac.uk. AD - National Institute of Health Research, Oxford Biomedical Research Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK. philippa.matthews@ndm.ox.ac.uk. AD - Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK. philippa.matthews@ndm.ox.ac.uk. LA - eng GR - WT_/Wellcome Trust/United Kingdom GR - 110110/WT_/Wellcome Trust/United Kingdom PT - Journal Article DEP - 20190626 PL - England TA - BMC Public Health JT - BMC public health JID - 100968562 RN - 0 (Antiviral Agents) RN - 0 (Hepatitis B Surface Antigens) RN - 0 (Hepatitis B Vaccines) RN - 0 (Hepatitis B e Antigens) RN - 99YXE507IL (Tenofovir) SB - IM MH - Adult MH - Antiviral Agents/*therapeutic use MH - Child MH - *Cost-Benefit Analysis MH - Developing Countries MH - Female MH - Hepatitis B/blood/diagnosis/*drug therapy/virology MH - Hepatitis B Surface Antigens/blood MH - Hepatitis B Vaccines/administration & dosage MH - Hepatitis B e Antigens/blood MH - Hepatitis B virus/*immunology MH - Hepatitis B, Chronic/blood/diagnosis/drug therapy/virology MH - Humans MH - Infant MH - Infectious Disease Transmission, Vertical/*prevention & control MH - Mass Screening MH - Models, Biological MH - Pregnancy MH - Pregnancy Complications, Infectious/blood/diagnosis/*drug therapy/virology MH - South Africa MH - Tenofovir/economics/*therapeutic use MH - Vaccination MH - Young Adult PMC - PMC6595556 OTO - NOTNLM OT - Africa OT - Elimination OT - Epidemiology OT - HBV OT - Hepatitis B OT - PMTCT OT - Tenofovir OT - Transmission COIS- The authors declare that they have no competing interests. EDAT- 2019/06/28 06:00 MHDA- 2019/09/04 06:00 PMCR- 2019/06/26 CRDT- 2019/06/28 06:00 PHST- 2018/12/19 00:00 [received] PHST- 2019/05/31 00:00 [accepted] PHST- 2019/06/28 06:00 [entrez] PHST- 2019/06/28 06:00 [pubmed] PHST- 2019/09/04 06:00 [medline] PHST- 2019/06/26 00:00 [pmc-release] AID - 10.1186/s12889-019-7095-4 [pii] AID - 7095 [pii] AID - 10.1186/s12889-019-7095-4 [doi] PST - epublish SO - BMC Public Health. 2019 Jun 26;19(1):829. doi: 10.1186/s12889-019-7095-4.