Cost-effectiveness of herpes simplex virus type 2 serologic testing and antiviral therapy in pregnancy.
OBJECTIVE
The purpose of this study was to determine whether serologic testing for herpes simplex virus type 2 (HSV-2) in pregnant women and their partners is cost-effective.


METHODS
A decision analysis model was developed to investigate the cost-effectiveness of providing type-specific serologic testing at week 15 of pregnancy for all women unaware of their HSV-2 status, and offering antiviral suppressive therapy from week 36 until delivery to all seropositive women. This scenario was compared with current care, in which only a minority of women diagnosed with genital herpes (GH) receives antiviral suppressive therapy (AST). In a third scenario, testing is offered to partners of pregnant women who test seronegative, and antiviral suppressive therapy is offered to the partners who test seropositive.


RESULTS
Compared with current care, offering testing and antiviral suppressive therapy to 100,000 pregnant women resulted in an incremental cost of $3.1 million, 15.7 fewer cases of neonatal herpes, 186 fewer cesarean deliveries, and an incremental cost per quality-adjusted life- year gained (QALY) of $18,680. Offering testing and suppressive therapy to both the pregnant women and their partners resulted in an increased cost of $8.6 million, 16.8 fewer cases of neonatal herpes, 192 fewer cesarean deliveries, and an incremental cost per QALY of $48,946 compared with no testing.


CONCLUSIONS
Compared with commonly accepted benchmarks for cost-effectiveness (<$50,000/QALY), type-specific HSV-2 serologic testing of pregnant women may be a cost-effective strategy.
Baker
David
D
Department of Obstetrics, Gynecology and Reproductive Medicine, Division of Infectious Disease, Health Sciences Center, State University of New York at Stony Brook, Stony Brook, NY, USA.
Brown
Zane
Z
Hollier
Lisa M
LM
Wendel
George D
GD
Hulme
Lisa
L
Griffiths
Dorothea A
DA
Mauskopf
Josephine
J
D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006558:Herpes Genitalis / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D018258:Herpesvirus 2, Human / Q000302:isolation & purification; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D011295:Prenatal Care; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012698:Serologic Tests / Q000191:economics; D014481:United States
D000998:Antiviral Agents