Costs of integrating hepatitis B screening and antiviral prophylaxis into routine antenatal care in Burkina Faso: Treat all versus targeted strategies

Andréa Gosset; Seydou Drabo; Patrizia Carrieri; Abdoul Salam Eric Tiendrebeogo; Jeanne Perpétue Vincent; Yasuhito Tanaka; Roger Sombié; Haoua Tall; Dramane Kania; Sylvie Boyer; Yusuke Shimakawa

doi:10.1002/ijgo.15515

Costs of integrating hepatitis B screening and antiviral prophylaxis into routine antenatal care in Burkina Faso: Treat all versus targeted strategies

Int J Gynaecol Obstet. 2024 Apr 3. doi: 10.1002/ijgo.15515. Online ahead of print.

Authors

Affiliations

¹ Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
² Laboratoire Mixte International de Vaccinologie (LAMIVAC), Bobo-Dioulasso, Burkina Faso.
³ Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France.
⁴ Department of Gastroenterology and Hepatology, Kumamoto University, Kumamoto, Japan.
⁵ Département d'Hépato-Gastroentérologie, Center Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso.
⁶ Center Muraz, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso.
⁷ International Research Center for Medical Sciences (IRCMS), Kumamoto University, Kumamoto, Japan.

PMID: 38567863
DOI: 10.1002/ijgo.15515

Abstract

Objective: Economic feasibility of eliminating mother-to-child transmission (MTCT) of hepatitis B virus (HBV) in highly endemic African countries remains uncertain. Prevention of MTCT (PMTCT) involves screening pregnant women for hepatitis B surface antigen (HBsAg), identifying those with high viral loads or hepatitis B e antigen (HBeAg), and administering tenofovir prophylaxis to high-risk women. We estimated the costs of integrating PMTCT services into antenatal care in Burkina Faso, based on four different strategies to select women for tenofovir prophylaxis: (1) HBV DNA (≥200 000 IU/mL), (2) HBeAg, (3) hepatitis B core-related antigen rapid diagnostic test (HBcrAg-RDT) and (4) all HBsAg-positive women.

Methods: Using a micro-costing approach, we estimated the incremental economic cost of integrating each strategy into routine antenatal care in 2024, compared to neonatal vaccination alone. Sensitivity analyses explored variations in prevalence, service coverage, test and tenofovir prices.

Results: HBcrAg-RDT strategy was the least expensive, with a total economic cost of US$3959689, compared to HBV DNA (US$6128875), HBeAg (US$4135233), and treat-all (US$4141206). The cost per pregnant woman receiving tenofovir prophylaxis varied from US$61.88 (Treat-all) to US$1071.05 (HBV DNA). The Treat-All strategy had the lowest marginal cost due to a higher number of women on tenofovir (66928) compared to HBV DNA (5722), HBeAg (10020), and HBcrAg-RDT (7234). In sensitivity analyses, the treat-all strategy became less expensive when the tenofovir price decreased.

Conclusion: HBcrAg-RDT minimizes resource use and costs, representing 0.61% of Burkina Faso's 2022 health budget. This study highlights the potential economic feasibility of these strategies and provides valuable resources for conducting cost-effectiveness analyses.

Keywords: Africa; costs; hepatitis B; mother‐to‐child transmission; screening; tenofovir; treatment.

Abstract

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