For a study, researchers sought to assess the cost-effectiveness of universal screening and immunization for hepatitis B immunity among pregnant women in the United States. They created a decision-analytic model to assess the outcomes, costs, and cost-effectiveness of universal hepatitis B virus (HBV) immune screening during pregnancy with vaccination of susceptible people versus no screening. A national cohort of 3.6 million women was chosen, which is roughly the number of live births in the United States each year. In addition to cost and quality-adjusted life-years, outcomes included HBV cases, hepatocellular cancer, decompensated cirrhosis, liver transplant, and mortality (QALYs). The model’s inputs were drawn from the literature, and the willingness-to-pay threshold was set at $50,000 per QALY. The robustness of the data was assessed using univariate sensitivity analysis and Monte Carlo simulation models.
In a hypothetical cohort of 3.6 million women, universal HBV immunity screening and vaccination led to 1,702 fewer instances of HBV, 7 fewer cases of decompensated cirrhosis, four fewer liver transplants, and 11 fewer deaths throughout a woman’s postpartum life expectancy. The incremental cost-effectiveness ratio for universal screening and immunization was determined to be $1,890 per QALY. Sensitivity evaluations revealed that the model was resilient even when HBV immunity was prevalent and the yearly probability of HBV acquisition was low. In the United States, universal HBV immunity screening and vaccination of vulnerable individuals was more cost-efficient than not screening and vaccinating pregnant women.
