Universal prenatal hepatitis B testing: is it cost-effective?

It was recently recommended that all pregnant women undergo prenatal hepatitis B screening. This change from previous policy (which advocated screening of only those individuals with recognized epidemiologic risk factors) is a very costly strategy to use in an effort to prevent the perinatal spread of hepatitis B in the "no-risk-factor" population. Inherent problems already exist in screening, related to the following: 1) the failure for disease transmission to occur in the majority of hepatitis B e antigen-negative pregnancies, 2) the lack of established efficacy of prophylaxis in the hepatitis B e antigen-negative pregnancy, 3) the preponderance of hepatitis B e antigen negativity in pregnant hepatitis B surface antigen carriers, and 4) the compliance of the mother to ensure that the prophylaxis program is accomplished. These are further magnified by the lower rates of hepatitis B surface antigen and hepatitis B e antigen positivity in the population without risk factors. The major expense of a screening program is the hepatitis B surface antigen testing of the mother. The cost to prevent a clinically important case of hepatitis B in the neonates of mothers with no risk factors is $180,000, which is 15 times the cost of preventing a case in neonates of mothers with risk factors. This price appears not to be cost-effective.