Little Sarah E, Caughey Aaron B
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
Am J Obstet Gynecol. 2005 Sep;193(3 Pt 2):1274-9. doi: 10.1016/j.ajog.2005.05.042.
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.
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 dollar 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.
既往文献表明，阿昔洛韦作为预防妊娠期间有症状的生殖器单纯疱疹病毒感染复发的女性的药物具有成本效益。我们通过增加质量调整生命年测量并考虑有单纯疱疹病毒感染诊断史但在妊娠期间无复发的女性来扩展这一分析。
设计了一个决策分析模型，比较了阿昔洛韦预防与不使用阿昔洛韦对有确诊生殖器单纯疱疹病毒感染史但在妊娠期间无复发的女性的效果。进行了敏感性分析和蒙特卡洛模拟以测试稳健性。
我们发现，必须治疗22286名女性才能预防1例新生儿死亡，治疗8985名女性才能预防1例受影响儿童，治疗177名女性才能预防1例剖宫产。与不使用阿昔洛韦相比，在妊娠36周时使用阿昔洛韦预防每人可节省约20美元，并使总质量调整生命年增加0.01。在单变量敏感性分析中，这一结果对所有合理的概率和质量调整生命年估计均具有稳健性。蒙特卡洛模拟表明，阿昔洛韦在100%的时间内具有成本效益，在99%以上的时间内可节省成本。
对于有确诊生殖器单纯疱疹病毒感染史但在妊娠期间无复发的孕妇，阿昔洛韦预防与不治疗相比，在广泛的假设范围内具有成本效益。
