Cost-effectiveness of routine antenatal varicella screening.
OBJECTIVE
To evaluate the cost-effectiveness of routine antenatal varicella serologic screening of pregnant women with negative or indeterminate varicella histories.


METHODS
Routine antenatal varicella screening was evaluated using a decision analytic model. Outcomes were varicella cases, deaths, and life-years. Probabilities were derived from the literature, and sensitivity analysis was performed when data were imprecise or subject to variation. The analysis was repeated to include the effect of a policy of routine screening and vaccination of all adults.


RESULTS
Routine antenatal varicella screening of history-negative women was not cost-effective unless the cost of screening was decreased six-fold, varicella exposure rates were greater than 6%, or there was a greater than three-fold decrease in varicella exposure in women testing nonimmune compared with unscreened women. These results were not sensitive to alterations in varicella-zoster immunoglobulin (Ig) effectiveness, varicella communicability, rates and timing of contact reporting, costs (per case, pneumonia, and death), or serologic test performance. If performed as part of a policy of universal screening of all history-negative adults (with vaccination of the majority of those testing nonimmune), routine antenatal varicella testing became cost-effective.


CONCLUSIONS
Routine antenatal varicella screening of all pregnant women with negative or indeterminate varicella histories is not cost-effective. It could be cost-effective in groups of women with increased exposure risk, or if part of a policy of screening and vaccination of all adults.
Glantz
J C
JC
Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, New York 14642, USA. cglantz@obgyn.rochester.edu
Mushlin
A I
AI
D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis; D002644:Chickenpox / Q000191:economics / Q000276:immunology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D014645:Herpesvirus 3, Human / Q000276:immunology; D006801:Humans; D007136:Immunoglobulins; D008403:Mass Screening / Q000191:economics*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000191:economics / Q000276:immunology / Q000517:prevention & control*; D012680:Sensitivity and Specificity
D000914:Antibodies, Viral; D007136:Immunoglobulins