Cost-effectiveness analysis of herpes simplex virus testing and treatment strategies in febrile neonates.
OBJECTIVE
To determine the clinical effectiveness and cost-effectiveness of testing for and empirically treating herpes simplex virus (HSV) infection in neonates with fever aged from birth to 28 days.


METHODS
Cost-effectiveness analysis.


METHODS
Decision model.


METHODS
Neonates with fever with no other symptoms and neonates with fever with cerebrospinal fluid (CSF) pleocytosis.


METHODS
Four clinical strategies: (1) HSV testing and empirical treatment while awaiting test results; (2) HSV testing and treatment if test results were positive for HSV or the patient had symptoms of HSV; (3) treatment alone without testing; or (4) no HSV testing or treatment unless the patient exhibited symptoms. The 2 HSV testing methods used were CSF HSV polymerase chain reaction (PCR) and comprehensive evaluation with blood HSV PCR, CSF HSV PCR, and multiple viral cultures.


METHODS
Twelve-month survival and quality-adjusted life expectancy with a cost-effectiveness threshold of $100,000 per quality-adjusted life year (QALY) gained.


RESULTS
Clinical strategy 1, when applied in febrile neonates with CSF pleocytosis, saved 17 lives per 10,000 neonates and was cost-effective using CSF HSV PCR testing ($55,652/QALY gained). The cost-effectiveness of applying clinical strategy 1 in all febrile neonates depended on the cost of the CSF HSV PCR, prevalence of disease, and parental preferences for neurodevelopmental outcomes. Clinical strategies using comprehensive HSV testing were not cost-effective in febrile neonates ($368,411/QALY gained) or febrile neonates with CSF pleocytosis ($110,190/QALY gained).


CONCLUSIONS
Testing with CSF HSV PCR and empirically treating with acyclovir sodium saves lives and is cost-effective in febrile neonates with CSF pleocytosis. It is not a cost-effective use of health care resources in all febrile neonates.
Caviness
A Chantal
AC
Texas Children's Hospital, Section of Pediatric Emergency Medicine, 6621 Fannin St, Houston, TX 77030, USA. accavine@texaschildrenshospital.org
Demmler
Gail J
GJ
Swint
J Michael
JM
Cantor
Scott B
SB
D000212:Acyclovir / Q000191:economics / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018450:Disease Progression; D005260:Female; D005334:Fever; D006561:Herpes Simplex / Q000175:diagnosis* / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D007231:Infant, Newborn; D007964:Leukocytosis / Q000134:cerebrospinal fluid; D008297:Male; D011336:Probability; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
D000998:Antiviral Agents; D000212:Acyclovir