Objective
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.
Results
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.
Conclusion
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
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Article info
Publication history
Accepted:
May 9,
2005
Received in revised form:
April 29,
2005
Received:
March 1,
2005
Footnotes
Supported by the National Institute of Child Health and Human Development, grant HD01262 (A.B.C.).
Presented at the 25th Annual Meeting of the Society for Maternal Fetal Medicine, February 7-12, 2005, Reno, Nevada.
Reprints not available from the authors.
Identification
Copyright
© 2005 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
