ANTENATAL SCREENING FOR HEPATITIS-B SURFACE-ANTIGEN - AN APPRAISAL OFITS VALUE IN A LOW-PREVALENCE AREA

The costs and projected benefits of universal screening for hepatitis B virus (HBV) infection in pregnant women in East Anglia are calculate d and compared with current practice. By adjusting data from West Midl ands region for ethnicity, the prevalence of maternal hepatitis B surf ace-antigen (HBsAg) positivity in East Anglia is predicted to be 0.083 % (1 in 1200). Published data on health risks of perinatal HBV infecti on and on immunisation efficacy are used to derive benefits of screeni ng. 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 a ntenatal screening in East Anglia would prevent 2.6 additional childho od carriers per year (compared with current practice), resulting in th e prevention of 0.7 deaths per year occurring 40-50 years in the futur e. The direct cost per (undiscounted) life-year saved would be pound 2 437, not including savings on treatment for chronic hepatitis B infect ion. Routine prenatal screening for maternal HBsAg should be introduce d without delay and continue even if HBV vaccination is introduced int o the UK childhood immunisation schedule.