Randolph A G, Hartshorn R M, Washington A E
Department of Pediatrics and Obstetrics, Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, USA.
Obstet Gynecol. 1996 Oct;88(4 Pt 1):603-10. doi: 10.1016/0029-7844(96)00261-x.
To compare the cost-effectiveness of oral acyclovir prophylaxis in late pregnancy to the current strategy of cesarean delivery for genital herpes lesions in the prevention of neonatal herpes transmission from mothers with recurrent genital infections.
Decision analysis was used to evaluate the clinical outcomes and direct costs of a prevention program from the health care payer's perspective. Probabilities were obtained from the literature and experts. Cost data were based on hospital costs and a cohort of herpes-infected neonates.
Acyclovir prophylaxis during late pregnancy followed by cesarean delivery for genital lesions at delivery in women with recurrent genital herpes requires 1818 women to follow this strategy to prevent one neonatal infection and 7.4 women to take acyclovir to prevent one outbreak of genital herpes at delivery, at a cost (above no intervention) of over $493,000 per neonatal infection prevented, $1.1 million per neonatal death or disability prevented, and $1444 per maternal outbreak prevented. Cesarean delivery for genital herpes lesions requires 386 women with recurrent herpes to undergo cesareans to prevent one neonatal infection, at a cost of more than $1.3 million per neonatal infection prevented and more than $3 million per neonatal death or disability prevented. If acyclovir is given and herpes lesions still occur, the incremental cost of requiring cesarean delivery for these women over vaginal delivery with culture and follow-up of exposed infants is more than $1.4 million per neonatal infection prevented.
Oral acyclovir prophylaxis in late pregnancy for women with recurrent genital herpes is more cost-effective than the current strategy of cesarean delivery for all women presenting with genital herpes lesions.
比较妊娠晚期口服阿昔洛韦预防与当前针对生殖器疱疹病灶进行剖宫产的策略在预防复发性生殖器感染母亲将新生儿疱疹传播给新生儿方面的成本效益。
从医疗保健支付方的角度，采用决策分析来评估预防方案的临床结果和直接成本。概率数据来自文献和专家。成本数据基于医院成本和一组感染疱疹的新生儿。
对于复发性生殖器疱疹女性，在妊娠晚期进行阿昔洛韦预防，然后在分娩时对生殖器病灶进行剖宫产，需要1818名女性采用此策略来预防一例新生儿感染，7.4名女性服用阿昔洛韦来预防分娩时一例生殖器疱疹发作，每预防一例新生儿感染的成本（高于无干预情况）超过49.3万美元，每预防一例新生儿死亡或残疾的成本为110万美元，每预防一例母亲疱疹发作的成本为1444美元。针对生殖器疱疹病灶进行剖宫产，需要386名复发性疱疹女性接受剖宫产来预防一例新生儿感染，每预防一例新生儿感染的成本超过130万美元，每预防一例新生儿死亡或残疾的成本超过300万美元。如果给予阿昔洛韦但仍出现疱疹病灶，对于这些女性，相比于经阴道分娩并对暴露婴儿进行培养和随访，进行剖宫产的增量成本为每预防一例新生儿感染超过140万美元。
对于复发性生殖器疱疹女性，妊娠晚期口服阿昔洛韦预防比当前针对所有出现生殖器疱疹病灶的女性进行剖宫产的策略更具成本效益。
