PharmacoEconomics & Outcomes News 475 - 9 Apr 2005

Routine HSV screening in pregnantwomen not economically viable

Routine testing for herpes simplex virus (HSV) amongpregnant women without a history of genital HSVinfection is "not a cost-effective intervention and remainsunwarranted", say investigators from the US.

They used a decision-analysis model to compare thecost effectiveness of the following three screeningstrategies in a hypothetical cohort of 100 000 pregnantwomen with no history of genital HSV-1 or -2 infection:• no maternal serological HSV screening performed

and caesarian delivery offered only if symptomaticgenital lesions present at delivery (current standardof care)

• maternal serological screening for HSV-1 and HSV-2performed and paternal screening of HSV-1, -2, orboth is performed if maternal serostatusdemonstrates susceptibility to either HSV type

• same as the second strategy with the addition ofprophylaxis with aciclovir 400mg three times daily at36 weeks’ gestation for women who areseropositive.

The first strategy, comprising the current standard ofcare, would result in a neonatal HSV infection incidenceof 1 per 5469 deliveries and would cost just over$US558 million per 100 000 women.* Screening andcounselling as outlined in the second strategy wouldincrease the cost by about $US11.6 million, and prevent4.7 neonatal infections and 2 associated significantneurological deficits or deaths. Therefore, the secondstrategy would cost an additional $US219 513 perquality-adjusted life-year (QALY) gained relative to thecurrent standard of care.

The addition of aciclovir prophylaxis would push costsup by a further $US16.5 million and prevent 9.4neonatal infections and 3.8 associated significantneurological deficits or deaths. The third strategy wouldcost an extra $US155 988 per QALY gained, comparedwith the current standard of care.

Sensitivity analysis showed that "not a single variation,even those variations that should bias the model heavilytoward screening, caused the cost per QALY to be<$50,000" for strategies two and three, say theinvestigators.* Costs (2003 values) were assessed from the perspective of thehealthcare system and were those related to screening, counselling,aciclovir, delivery, acute and long-term care for neurological deficitsand death. Costs and QALYs were discounted at a rate of 3% annually.

Thung SF, et al. The cost-effectiveness of routine antenatal screening for maternalherpes simplex virus-1 and -2 antibodies. American Journal of Obstetrics andGynecology 192: 483-488, No. 2, Feb 2005 801005529

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PharmacoEconomics & Outcomes News 9 Apr 2005 No. 4751173-5503/10/0475-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved