Universal hepatitis B screening and vaccination for pregnant women

A recent analysis published in Obstetrics & Gynecology considers screening for hepatitis B antibodies and vaccinating pregnant women without immunity to be a cost-effective health measure.

Although vaccination is not routine during pregnancy, guidelines from the American College of Obstetricians and Gynecologists recommend screening and vaccinating at-risk women for hepatitis B during pregnancy.

In their recent study, Dr. Prabhu and her colleagues determined how universal hepatitis B surface antibody screening and vaccination for hepatitis B affected factors like cost, cost-effectiveness, and outcomes. They included hepatitis B virus cases and long-term problems associated with hepatitis B infection, like hepatocellular carcinoma, decompensated cirrhosis, liver transplant, and death. 

They found the universal screening and vaccination program cost-effective, with fewer cases of hepatitis B, deaths, decompensated cirrhosis cases, and liver transplants in their model. They also found an incremental cost-effectiveness ratio of $1,890 per quality-adjusted life-years (QALYs) and the total increased lifetime cohort cost as $13,841,889. This model holds true even in scenarios with a high level of hepatitis B immunity and no presence of at-risk women in the model.

If real-world studies show that a hepatitis B universal screening and vaccination program is cost-effective, guidelines must reconsider the population to be screened and vaccinated. 

Under guidelines that direct all pregnant women to be screened and vaccinated for hepatitis B regardless of risk, conducting one extra blood test, among many other blood tests at the first prenatal visit, is no harm.

Thus, Clinicians must consider adding hepatitis B screening to prenatal care, given that ACOG recently released routine hepatitis C screening for pregnant women as a practice advisory.

Craven J. Universal hepatitis B screening, vaccination deemed cost-effective for pregnant women. MDEdge. February 10, 2022. https://www.mdedge.com/obgyn/article/251664/preventive-care/universal-hepatitis-b-screening-vaccination-deemed-cost?reg=1

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