Prevention of Vertical Transmission of Hepatitis B Virus A Randomized Clinical Trial and A Cost - Effectiveness Analysis

Abstract

A randomized clinical trial and economic analysis was conducted to assess the cost-effectiveness of combined and active immunization for prevention of vertical transmission of hepatitis B virus in high risk newborns (mothers with + HBsAg and + HBeAg). Eighty newborns whose mothers had positive HBsAg and HBeAg were ran domized into either combined or only active immunization. These newborns were fol lowed up for 1 year for HBsAg and HBeAg using ELISA technique. The rates of protection of vertical transmission of HBV by combined and active immunization alone were 91.9 and 84.2 per cent respectively. There was no statistically significant differ ence between the 2 regimens. The cost for prevention of one case of vertival transmis sion of HBV was 714 baht for vaccine alone and 1847 baht for combined immunization. Combined immunization should be as cost-effective as active immunization only if the cost of HBIG is less than 57 baht or the effectiveness of the vaccine alone regimen is less than 30 per cent. 

Although combined immunization offers the most effective measure for prevention of vertical transmission of HBV. Immunization by vaccine alone is much more cost-ef fective and should be used for mass immunization. (Thai J Obstet Gynaecol 1989;1:123 7.)