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Quantitative hepatitis B surface antigen (qHBsAg) testing could be used as a surrogate marker to identify high viral load carriers, but there is limited data in pregnancy. We conducted a prospective observational study to determine the cost\u2010effectiveness and utility of qHBsAg as a valid surrogate marker of HBV DNA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Pregnant patients with chronic hepatitis B were recruited from a tertiary referral centre. HBV DNA levels and qHBsAg were assessed in the second to third trimester. Statistical analysis was performed by Spearman's rank correlation and student's <jats:italic>t<\/jats:italic>\u2010test. The cost\u2010effectiveness of qHBsAg as compared to HBV DNA testing was calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ninety nine women with 103 pregnancies, median age 32 years, 65% Asian, 23% African and 12% other [Hispanic, Caucasian] were enrolled. Overall, 23% (23\/99) were HBV e Ag (HBeAg)\u2010positive. A significant correlation between qHBsAg and HBV DNA levels was noted in HBeAg\u2010positive patients (<jats:italic>r<\/jats:italic> = 0.79, <jats:italic>P<\/jats:italic> &lt; 0.05) but not in HBeAg\u2010negative patients (<jats:italic>r<\/jats:italic> = 0.17, <jats:italic>P<\/jats:italic> = 0.06). In receiver operating characteristic analysis, the optimal qHBsAg cut\u2010off values for predicting maternal viraemia associated with immunoprophylaxis failure (i.e., HBV DNA \u22657 log<jats:sub>10<\/jats:sub> IU\/ml) was 4.3 log<jats:sub>10<\/jats:sub> IU\/ml (accuracy 98.7%, sensitivity 94.7%, specificity 94.4%) (95% CI, 97\u2013100%, <jats:italic>P<\/jats:italic> &lt; 0.05). Use of HBV DNA as compared to qHBsAg costs approximately $20 000 more per infection prevented.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In resource poor regions, qHBsAg could be used as a more cost\u2010effective marker for high maternal viraemia, and indicate when anti\u2010HBV nucleos\/tide analogue therapy should be used to prevent HBV immunoprophylaxis failure.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.13139","type":"journal-article","created":{"date-parts":[[2016,4,10]],"date-time":"2016-04-10T12:23:41Z","timestamp":1460291021000},"page":"1604-1610","source":"Crossref","is-referenced-by-count":17,"title":["Cost\u2010effectiveness of quantitative hepatitis B virus surface antigen testing in pregnancy in predicting vertical transmission risk"],"prefix":"10.1111","volume":"36","author":[{"given":"Golasa","family":"Samadi Kochaksaraei","sequence":"first","affiliation":[{"name":"Department of Medicine University of Calgary Calgary AB Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen E.","family":"Congly","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Calgary Calgary AB Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trudy","family":"Matwiy","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Calgary Calgary AB Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eliana","family":"Castillo","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Calgary Calgary AB Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven R.","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Alberta Children's Hospital University of Calgary Calgary AB Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen L.","family":"Charlton","sequence":"additional","affiliation":[{"name":"Provincial Laboratory for Public Health (ProvLab) University of Alberta Hospital Edmonton AB Canada"},{"name":"Laboratory Medicine and Pathology University of Alberta Edmonton AB Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla S.","family":"Coffin","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Calgary Calgary AB Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,5,13]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"WHO.Hepatitis B: World Health Organization fact sheet 204 (revised July 2014). 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