Skip to main content
PMC home page
Epidemiology and Infection logoLink to Epidemiology and Infection
. 1996 Aug;117(1):121–131. doi: 10.1017/s0950268800001217

Ante-natal screening for hepatitis B surface antigen: an appraisal of its value in a low prevalence area.

M J Dwyer 1, P G McIntyre 1
PMCID: PMC2271686  PMID: 8760959

Abstract

The costs and projected benefits of universal screening for hepatitis B virus (HBV) infection in pregnant women in East Anglia are calculated and compared with current practice. By adjusting data from West Midlands region for ethnicity, the prevalence of maternal hepatitis B surface-antigen (HBsAg) positivity in East Anglia is predicted to be 0.083% (1 in 1200). Published data on health risks of perinatal HBV infection and on immunisation efficacy are used to derive benefits of screening. The marginal direct cost of screening is identified from regional sources. Current clinical practice in East Anglia identifies 7 surface-antigen positive mothers per year, whereas 22 are expected. Routine antenatal screening in East Anglia would prevent 2.6 additional childhood carriers per year (compared with current practice), resulting in the prevention of 0.7 deaths per year occurring 40-50 years in the future. The direct cost per (undiscounted) life-year saved would be Pounds 2437, not including savings on treatment for chronic hepatitis B infection. Routine prenatal screening for maternal HBsAg should be introduced without delay and continue even if HBV vaccination is introduced into the UK childhood immunisation schedule.

Full text

PDF
131

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alter M. J. Community acquired viral hepatitis B and C in the United States. Gut. 1993;34(2 Suppl):S17–S19. doi: 10.1136/gut.34.2_suppl.s17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. André F. E. Overview of a 5-year clinical experience with a yeast-derived hepatitis B vaccine. Vaccine. 1990 Mar;8 (Suppl):S74–S80. doi: 10.1016/0264-410x(90)90222-8. [DOI] [PubMed] [Google Scholar]
  3. Arevalo J. A., Washington A. E. Cost-effectiveness of prenatal screening and immunization for hepatitis B virus. JAMA. 1988 Jan 15;259(3):365–369. [PubMed] [Google Scholar]
  4. Beasley R. P., Hwang L. Y., Lee G. C., Lan C. C., Roan C. H., Huang F. Y., Chen C. L. Prevention of perinatally transmitted hepatitis B virus infections with hepatitis B immune globulin and hepatitis B vaccine. Lancet. 1983 Nov 12;2(8359):1099–1102. doi: 10.1016/s0140-6736(83)90624-4. [DOI] [PubMed] [Google Scholar]
  5. Beasley R. P., Hwang L. Y., Lin C. C., Chien C. S. Hepatocellular carcinoma and hepatitis B virus. A prospective study of 22 707 men in Taiwan. Lancet. 1981 Nov 21;2(8256):1129–1133. doi: 10.1016/s0140-6736(81)90585-7. [DOI] [PubMed] [Google Scholar]
  6. Beasley R. P., Hwang L. Y. Postnatal infectivity of hepatitis B surface antigen-carrier mothers. J Infect Dis. 1983 Feb;147(2):185–190. doi: 10.1093/infdis/147.2.185. [DOI] [PubMed] [Google Scholar]
  7. Beasley R. P., Trepo C., Stevens C. E., Szmuness W. The e antigen and vertical transmission of hepatitis B surface antigen. Am J Epidemiol. 1977 Feb;105(2):94–98. doi: 10.1093/oxfordjournals.aje.a112370. [DOI] [PubMed] [Google Scholar]
  8. Beath S. V., Boxall E. H., Watson R. M., Tarlow M. J., Kelly D. A. Fulminant hepatitis B in infants born to anti-HBe hepatitis B carrier mothers. BMJ. 1992 May 2;304(6835):1169–1170. doi: 10.1136/bmj.304.6835.1169. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Boxall E. H. Antenatal screening for carriers of hepatitis B virus. BMJ. 1995 Nov 4;311(7014):1178–1179. doi: 10.1136/bmj.311.7014.1178. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Buxton M. J., West R. R. Cost-benefit analysis of long-term haemodialysis for chronic renal failure. Br Med J. 1975 May 17;2(5967):376–379. doi: 10.1136/bmj.2.5967.376. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Casscells W. Heart transplantation. Recent policy developments. N Engl J Med. 1986 Nov 20;315(21):1365–1368. doi: 10.1056/NEJM198611203152129. [DOI] [PubMed] [Google Scholar]
  12. Chrystie I., Sumner D., Palmer S., Kenney A., Banatvala J. Screening of pregnant women for evidence of current hepatitis B infection: selective or universal? Health Trends. 1992;24(1):13–15. [PubMed] [Google Scholar]
  13. Dobson S., Scheifele D., Bell A. Assessment of a universal, school-based hepatitis B vaccination program. JAMA. 1995 Oct 18;274(15):1209–1213. [PubMed] [Google Scholar]
  14. Francis D. P. The public's health unprotected. Reversing a decade of underutilization of hepatitis B vaccine. JAMA. 1995 Oct 18;274(15):1242–1243. [PubMed] [Google Scholar]
  15. Johnson P. J., Krasner N., Portmann B., Eddleston A. L., Williams R. Hepatocellular carcinoma in Great Britain: influence of age, sex, HBsAg status, and aetiology of underlying cirrhosis. Gut. 1978 Nov;19(11):1022–1026. doi: 10.1136/gut.19.11.1022. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Kane M. A., Hadler S. C., Margolis H. S., Maynard J. E. Routine prenatal screening for hepatitis B surface antigen. JAMA. 1988 Jan 15;259(3):408–409. [PubMed] [Google Scholar]
  17. Kane M. A., Hadler S. C., Margolis H. S., Maynard J. E. Routine prenatal screening for hepatitis B surface antigen. JAMA. 1988 Jan 15;259(3):408–409. [PubMed] [Google Scholar]
  18. Kane M. A. Progress on the control of hepatitis B infection through immunisation. Gut. 1993;34(2 Suppl):S10–S12. doi: 10.1136/gut.34.2_suppl.s10. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Kankaanpä J. Cost-effectiveness of liver transplantation. Transplant Proc. 1987 Oct;19(5):3864–3866. [PubMed] [Google Scholar]
  20. Mangtani P., Hall A. J., Normand C. E. Hepatitis B vaccination: the cost effectiveness of alternative strategies in England and Wales. J Epidemiol Community Health. 1995 Jun;49(3):238–244. doi: 10.1136/jech.49.3.238. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Margolis H. S., Coleman P. J., Brown R. E., Mast E. E., Sheingold S. H., Arevalo J. A. Prevention of hepatitis B virus transmission by immunization. An economic analysis of current recommendations. JAMA. 1995 Oct 18;274(15):1201–1208. [PubMed] [Google Scholar]
  22. McQuillan G. M., Townsend T. R., Johannes C. B., Dillard T., Molteni R. A., Ness P. M., Niebyl J. R. Prevention of perinatal transmission of hepatitis B virus: the sensitivity, specificity, and predictive value of the recommended screening questions to detect high-risk women in an obstetric population. Am J Epidemiol. 1987 Sep;126(3):484–491. doi: 10.1093/oxfordjournals.aje.a114680. [DOI] [PubMed] [Google Scholar]
  23. Parsonage M., Neuburger H. Discounting and health benefits. Health Econ. 1992 Apr;1(1):71–76. doi: 10.1002/hec.4730010110. [DOI] [PubMed] [Google Scholar]
  24. Polakoff S., Vandervelde E. M. Immunisation of neonates at high risk of hepatitis B in England and Wales: national surveillance. BMJ. 1988 Jul 23;297(6643):249–253. doi: 10.1136/bmj.297.6643.249. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Sheldon T. A. Discounting in health care decision-making: time for a change? J Public Health Med. 1992 Sep;14(3):250–256. [PubMed] [Google Scholar]
  26. Sherlock S. Hepatitis B: the disease. Vaccine. 1990 Mar;8 (Suppl):S6–S23. doi: 10.1016/0264-410x(90)90206-2. [DOI] [PubMed] [Google Scholar]
  27. Sinatra F. R., Shah P., Weissman J. Y., Thomas D. W., Merritt R. J., Tong M. J. Perinatal transmitted acute icteric hepatitis B in infants born to hepatitis B surface antigen-positive and anti-hepatitis Be-positive carrier mothers. Pediatrics. 1982 Oct;70(4):557–559. [PubMed] [Google Scholar]
  28. Smith C. P., Parle M., Morris D. J. Implementation of government recommendations for immunising infants at risk of hepatitis B. BMJ. 1994 Nov 19;309(6965):1339–1339. doi: 10.1136/bmj.309.6965.1339. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Spring D. B., Quesenberry C. P., Jr Costs of low-osmolar contrast media. JAMA. 1991 Aug 28;266(8):1081–1082. doi: 10.1001/jama.1991.03470080051027. [DOI] [PubMed] [Google Scholar]
  30. Stevens C. E., Taylor P. E., Tong M. J., Toy P. T., Vyas G. N., Nair P. V., Weissman J. Y., Krugman S. Yeast-recombinant hepatitis B vaccine. Efficacy with hepatitis B immune globulin in prevention of perinatal hepatitis B virus transmission. JAMA. 1987 May 15;257(19):2612–2616. doi: 10.1001/jama.257.19.2612. [DOI] [PubMed] [Google Scholar]
  31. Tan C. C., Guan R., Yap I., Tay H. H., Kang J. Y. Horizontal or vertical transmission of hepatitis B virus? A serological survey in family members of hepatitis B carriers in Singapore. Trans R Soc Trop Med Hyg. 1991 Sep-Oct;85(5):656–659. doi: 10.1016/0035-9203(91)90384-b. [DOI] [PubMed] [Google Scholar]
  32. Tormans G., Van Damme P., Carrin G., Clara R., Eylenbosch W. Cost-effectiveness analysis of prenatal screening and vaccination against hepatitis B virus--the case of Belgium. Soc Sci Med. 1993 Jul;37(2):173–181. doi: 10.1016/0277-9536(93)90453-b. [DOI] [PubMed] [Google Scholar]
  33. Wheeley S. M., Boxall E. H., Tarlow M. J., Gatrad A. R., Anderson J., Bissenden J., Chin K. C., Mayne A. Hepatitis B vaccine in the prevention of perinatally transmitted hepatitis B virus infection: final report on a West Midlands pilot study. J Med Virol. 1990 Feb;30(2):113–116. doi: 10.1002/jmv.1890300207. [DOI] [PubMed] [Google Scholar]
  34. Wheeley S. M., Jackson P. T., Boxall E. H., Tarlow M. J., Gatrad A. R., Anderson J., Bissenden J. Prevention of perinatal transmission of hepatitis B virus (HBV): a comparison of two prophylactic schedules. J Med Virol. 1991 Nov;35(3):212–215. doi: 10.1002/jmv.1890350312. [DOI] [PubMed] [Google Scholar]
  35. Wheeley S. M., Tarlow M. J., Boxall E. H. Chronic hepatitis B in male and female children of HBsAg carrier mothers. J Hepatol. 1989 Mar;8(2):226–231. doi: 10.1016/0168-8278(89)90011-1. [DOI] [PubMed] [Google Scholar]
  36. Wong V. C., Ip H. M., Reesink H. W., Lelie P. N., Reerink-Brongers E. E., Yeung C. Y., Ma H. K. Prevention of the HBsAg carrier state in newborn infants of mothers who are chronic carriers of HBsAg and HBeAg by administration of hepatitis-B vaccine and hepatitis-B immunoglobulin. Double-blind randomised placebo-controlled study. Lancet. 1984 Apr 28;1(8383):921–926. doi: 10.1016/s0140-6736(84)92388-2. [DOI] [PubMed] [Google Scholar]
  37. Woo D., Cummins M., Davies P. A., Harvey D. R., Hurley R., Waterson A. P. Vertical transmission of hepatitis B surface antigen in carrier mothers in two west London hospitals. Arch Dis Child. 1979 Sep;54(9):670–675. doi: 10.1136/adc.54.9.670. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Yeoh E. K. Hepatitis B virus infection in children. Vaccine. 1990 Mar;8 (Suppl):S29–S30. doi: 10.1016/0264-410x(90)90212-5. [DOI] [PubMed] [Google Scholar]

Articles from Epidemiology and Infection are provided here courtesy of Cambridge University Press

RESOURCES