Cost-effectiveness analysis of herpes simplex virus testing and treatment strategies in febrile neonates.

Abstract

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.

DESIGN:

Cost-effectiveness analysis.

SETTING:

Decision model.

PATIENTS:

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

INTERVENTIONS:

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.

MAIN OUTCOME MEASURES:

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.

• Authors: A Chantal Caviness, Gail J Demmler, J Michael Swint, Scott B Cantor
• Journal: Archives of pediatrics & adolescent medicine (Arch Pediatr Adolesc Med) Vol. 162 Issue 7 Pg. 665-74 (Jul 2008) ISSN: 1538-3628 [Electronic] United States
• PMID: 18606938 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antiviral Agents
• Acyclovir

Topics

• Acyclovir (economics, therapeutic use)
• Antiviral Agents (economics, therapeutic use)
• Cost-Benefit Analysis
• Decision Support Techniques
• Disease Progression
• Female
• Fever
• Herpes Simplex (diagnosis, drug therapy, economics)
• Humans
• Infant, Newborn
• Leukocytosis (cerebrospinal fluid)
• Male
• Probability
• Quality-Adjusted Life Years
• Treatment Outcome