Análisis coste-efectividad de la prevención prenatal frente al virus de la hepatitis B

Resumen

Vertical infection with the hepatitis B virus is an important cause of chronic morbidity which can perpetuate the illness in the community. Prenatal prevention is possible by detection of HBsAg carriers and active and passive immunization of their newborns. The implementation of a screening program for every pregnant woman needs to be economically evaluated, establish the costs and profits of such a decision. The cost-effectiveness of such a program was analyzed by using a decision-trees. The options evaluated were: a) A HBsAg screening program including every pregnant woman, with active and passive immunization of all children born to carriers. b) Do not carry-out the program. The involved costs are those incurred by screening, immunization and treatment of acute and chronic infection. The effectivity is evaluated by the number of cases of HBV infections avoided as a result of coverage of both screening and immunization, the test sensitivity and immunization efficacy. The constant pesetas (pts) per avoided case is shown for 1992. The cost-effectiveness ratio varied from 1,662,000 pts for Soria (with a carrier prevalence of 0.22%) to 88,000 pts for Barcelona (with a carrier prevalence of 1.2%). We conclude that in Spanish provinces with a lower prevalence rate it might be prudent to carry-out a prenatal questionnaire in order to screen for mothers at risk. For other areas, the additional cost per avoided case is so small that it could justify a general screening program. In areas with a prevalence greater than 1.5% there is an additional savings for each avoided case.