Cost-effectiveness analysis of prenatal screening and vaccination against hepatitis B virus--the case of Belgium.

The study examines the cost-effectiveness of screening pregnant women in Belgium for the presence of hepatitis B virus (HBV) and of vaccinating the newborns if necessary. The alternative strategy considered is 'doing nothing'. The rate of carriership among a sample of pregnant women in Belgium amounts to 0.67%. If a pregnant woman is a carrier of the virus, there is an average probability of 30% that she will transmit the virus to her newborn. Later in life, this baby will be at risk from serious complications, such as chronic active hepatitis, cirrhosis and primary hepatocellular cancer. However, medical costs will be induced by screening and vaccination campaigns, lab-tests, vaccine costs, etc. On the other hand, resources will be saved by the prevention of severe complications of the disease. However, costs dominate savings, the incremental cost-effectiveness ratio for the screening and vaccination strategy amounting to 583,581 BEF per life-year saved. To check the stability of the cost-effectiveness ratio, a sensitivity analysis has been performed on some crucial parameters: the ratio is found to be sensitive to the prevalence of HBV among pregnant women, to the costs for screening and vaccination and to the discount rate. Increasing the treatment costs for a HBV complication hardly changes the cost-effectiveness ratio.