Acyclovir prophylaxis for pregnant women with a known history of herpes simplex virus: A cost-effectiveness analysis


      Previous literature has shown acyclovir to be cost-effective as prophylaxis for women with genital symptomatic herpes simplex virus infection recurrence during pregnancy. We extend this analysis by adding quality-adjusted life year measurements and considering women with a diagnosed history of herpes simplex virus infection but without recurrence in pregnancy.

      Study design

      A decision analytic model was designed that compared acyclovir prophylaxis versus no acyclovir for women with a history of diagnosed genital herpes simplex virus infection but without recurrence in pregnancy. Sensitivity analysis and Monte Carlo simulations were performed to test for robustness.


      We found that 22,286 women must be treated to prevent 1 neonatal death, 8985 women to prevent 1 affected child, and 177 women to prevent 1 cesarean delivery. As compared with no acyclovir, acyclovir prophylaxis at 36 weeks of gestation saves approximately $20 per person and increases total quality-adjusted life years by 0.01. In univariate sensitivity analysis, this result was robust to all reasonable probability and quality-adjusted life year estimates. Monte Carlo simulation demonstrated acyclovir to be cost-effective 100% of the time and cost saving >99% of the time.


      Acyclovir prophylaxis versus no treatment for pregnant women with a diagnosed history of genital herpes simplex virus infection but without recurrence during pregnancy is cost-effective over a wide range of assumptions.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Gutierrez K.M.
        • Falkovitz Halpern M.S.
        • Maldonado Y.
        • Arvin A.M.
        The epidemiology of neonatal herpes simplex virus infections in California 1985 to 1995.
        J Infect Dis. 1999; 180: 199-202
        • Whitley R.
        Neonatal herpes simplex virus infection.
        Curr Opin Infect Dis. 2004; 7: 243-246
        • Randolph A.G.
        • Washington E.
        • Prober C.G.
        Cesarean delivery for women presenting with genital herpes lesions.
        JAMA. 1993; 270: 77-82
        • Brown Z.A.
        • Wald A.
        • Morrow R.A.
        • Selke S.
        • Zeh J.
        • Corey L.
        Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant.
        JAMA. 2003; 289: 203-209
        • Sheffield J.S.
        • Hollier L.M.
        • Hill J.B.
        • Stuart G.S.
        • Wendel G.D.
        Acyclovir prophylaxis to prevent herpes simplex virus recurrence at delivery: a systematic review.
        Obstet Gynecol. 2003; 102: 1396-1403
        • Braig L.
        • Luton D.
        • Sibony O.
        • Edlinger C.
        • Boissinot C.
        • Blot P.
        • et al.
        Acyclovir prophylaxis in late pregnancy prevents recurrent genital herpes and viral shedding.
        Eur J Obstet Gynecol Reprod Biol. 2001; 96: 55-58
        • Randolph A.G.
        • Hartshorn R.M.
        • Washington A.E.
        Acyclovir prophylaxis in late pregnancy to prevent neonatal herpes: a cost-effectiveness analysis.
        Obstet Gynecol. 1996; 88: 603-610
        • Scott L.L.
        • Alexander J.
        Cost-effectiveness of acyclovir suppression to prevent recurrent genital herpes in pregnancy.
        Am J Perinat. 1998; 15: 57-62
        • Masoaka T.
        • Shibata H.
        • Amaki I.
        • Takeo H.
        • Sakurai K.
        • Ise T.
        • et al.
        [The clinical effects of a new antiviral 9-(2-hydroxyethoxymethyl) guanine (acyclovir) against herpes virus infections].
        Gan To Kagaku Ryoho. 1983; 10: 944-952
      1. National Center for Health Statistics. National Vital Statistics United States for 2003. Hyattsville, Md: Public Health Services; 2003.

        • Baker D.
        • Brown Z.
        • Hollier L.M.
        • Wendel Jr., G.D.
        • Hulme L.
        • Griffiths D.A.
        • et al.
        Cost-effectiveness of herpes simplex virus type 2 serological testing and antiviral therapy in pregnancy.
        Am J Obstet Gynecol. 2004; 191: 2074-2084
        • Lilford R.J.
        • van Coeverden de Groot H.A.
        • Moore P.J.
        • Bingham P.
        The relative risks of caesarean section (intrapartum and elective) and vaginal delivery: a detailed analysis to exclude the effects of medical disorders and other acute pre-existing physiological disturbances.
        BJOG. 1990; 97: 883-892
        • Solomon L.
        • Cannon M.J.
        • Reyes M.
        • Graber J.M.
        • Wetherall N.T.
        • Reeves W.C.
        Epidemiology of recurrent genital herpes simplex virus types 1 and 2.
        Sex Transm Infect. 2003; 79: 456-459
        • Rouse D.J.
        • Stringer J.S.A.
        An appraisal of screening for maternal type-specific herpes simplex virus antibodies to prevent neonatal herpes.
        Am J Obstet Gynecol. 2000; 183: 400-406
      2. United States Department of Labor Bureau of Labor Statistics. Consumer Price Indices. Washington DC: United States Bureau of Labor Statistics; 2005.

        • Barnabas R.V.
        • Carabin H.
        • Garnett G.P.
        The potential role of suppressive therapy for sex partners in the prevention of neonatal herpes: a health economic analysis.
        Sex Trans Infect. 2002; 78: 425-429
        • Waitzman N.J.
        • Romano P.S.
        • Scheffler R.M.
        Estimates of the economic costs of birth defects.
        Inquiry. 1994; 31: 188-205
        • Rouse D.J.
        • Owen J.
        • Goldenberg R.L.
        • Cliver S.P.
        The effectiveness and costs of elective cesarean delivery for fetal macrosomia diagnosed by ultrasound.
        JAMA. 1996; 276: 1480-1486
        • Gold M.R.
        • Siegel J.E.
        • Russell L.B.
        • Weinstein M.C.
        Cost-effectiveness in health and medicine.
        Oxford University Press, New York1996
        • Angeja A.
        • Caughey A.B.
        • Vargas J.
        • Gomez R.
        • Washington A.E.
        Chilean women's preferences regarding mode of delivery: Which do they prefer and why?.
        Obstet Gynecol. 2004; 103: 117S
        • Kuppermann M.
        • Nease R.F.
        • Learman L.A.
        • Gates E.
        • Blumberg B.
        • Washington A.E.
        Procedure-related miscarriages and Down syndrome affected births: Implications for prenatal testing based on women's preferences.
        Obstet Gynecol. 2000; 96: 511-516
      3. Strauss D, Shavelle R, Day S. Life Expectancy Project. Available from: Accessed April 25, 2005.

        • Saigal S.
        • Stoskopf B.L.
        • Feeny D.
        • Furlong W.
        • Burrows E.
        • Rosenbaum P.L.
        • et al.
        Differences in preferences for neonatal outcome among health care professionals, parents and adolescents.
        JAMA. 1999; 281: 1991-1997
        • Brown Z.A.
        • Selke S.
        • Zeh J.
        • Kopelman J.
        • Maslow A.
        • Ashley R.L.
        • et al.
        The acquisition of herpes simplex virus during pregnancy.
        N Engl J Med. 1997; 337: 509-515
        • Stone K.
        • Reiff-Eldridge R.
        • White A.D.
        • Cordero J.F.
        • Brown Z.
        • Alexander E.R.
        • et al.
        Pregnancy outcome following systematic prenatal acyclovir exposure: conclusions from the international acyclovir pregnancy registry, 1984-1999.
        Birth Defects Res Clin Mol Teratol. 2004; 70: 201-207