Decision tree and cost-benefit analysis on strategies related to preventing maternal-infantile transmission of hepatitis B virus infection
10.3760/cma.j.issn.0254-6450.2013.03.016
- VernacularTitle:乙型肝炎病毒母婴传播阻断策略的决策分析及成本效益评价
- Author:
Guo SHI
1
,
2
;
Shun-Xiang ZHANG
Author Information
1. 450001 郑州大学公共卫生学院
2. 深圳市疾病预防控制中心
- Keywords:
Hepatitis B virus;
Maternal-infantile transmission;
Vaccination;
Cost-benefit analysis;
Decision analysis;
Markov model
- From:
Chinese Journal of Epidemiology
2013;34(3):273-278
- CountryChina
- Language:Chinese
-
Abstract:
Objective To synthesize relevant data and to analyze the benefit-cost ratio on strategies related to preventing the maternal-infantile transmission of hepatitis B virus infection and to explore the optimal strategy.Methods A decision tree model was constructed according to the strategies of hepatitis B immunization and a Markov model was conducted to simulate the complex disease progress after HBV infection.Parameters in the models were drawn from meta-analysis and information was collected from field study and review of literature.Economic evaluation was performed to calculate costs,benefit,and the benefit-cost ratio.Sensitivity analysis was also conducted and a tornado graph was drawn.Results In view of the current six possible strategies in preventing maternal-infantile transmission of hepatitis B virus infection,a multi-stage decision tree model was constructed to screen hepatitis B surface antigen (HBsAg) or screen for HBsAg then hepatitis B e antigen (HBeAg).Dose and the number of injections of HBIG and hepatitis B vaccine were taken into consideration in the model.All the strategies were considered to be cost-saving,while the strategy of screening for HBsAg and then offering hepatitis B vaccine of 10 μg × 3 for all neonates with hepatitis B immunoglobulin (HBIG) of 100 IU × 1 for the neonates born to mothers who tested positive for HBsAg appeared with most cost-saving.In the strategies,the benefit-cost ratio of using 100 IU HBIG was similar to 200 IU HBIG,and one shot of HBIG was superior to two shots.Results from sensitivity analysis suggested that the rates of immunization and the efficacy of the strategy in preventing maternal-infantile transmission were the main sensitive variables in the model.Conclusion The passive-active immune-prophylaxis strategy that using 10μg hepatitis B vaccine combined with 100 IU HBIG seemed to be the optimal strategy in preventing maternal-infantile transmission,while the rates of immunization and the efficacy of the strategy played the key roles in choosing the ideal strategy.
