The potential role of suppressive therapy for sex partners in the prevention of neonatal herpes: a health economic analysis
- 1Nuffield Department of Medicine, University of Oxford, Oxford, UK
- 2Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College, St Mary’s, London, UK
- Correspondence to: G P Garnett, Department Infectious Disease Epidemiology, Faculty of Medicine, Imperial College, St Mary’s, Norfolk Place, London W2 1PG, UK; g.garnett{at}ic.ac.uk
- Accepted 20 June 2002
Abstract
Background: The development of suppressive therapy and type specific tests for herpes infections allow for screening to reduce the risk of neonatal herpes.
Objectives: To assess the potential effectiveness, cost effectiveness, and benefit of suppressive therapy among herpes simplex virus serodiscordant sex partners during pregnancy.
Methods: Decision and economic analyses are used to compare the incidence and costs of neonatal herpes in California (2000) for three interventions: (1) no management; (2) current guidelines (caesarean delivery for women with lesions); (3) screening for women at risk and use of suppressive treatment in sex partners.
Results: Screening and suppressive therapy are the most effective interventions, while current guidelines have limited effectiveness, but the latter provide the most cost effective results.
Conclusions: While current guidelines are cost saving, they forgo a potential 82% decrease in neonatal herpes incidence that would be possible with screening and suppressive therapy if society were willing to pay the necessary US$363 000 per case prevented. To evaluate HSV screening and drug therapy completely, clinical trials and an economic assessment of infant mortality “value” to society are required.
