Scott L L, Alexander J
University of Texas Southwestern Medical School, Department of Obstetrics and Gynecology, Dallas 75235-9032, USA.
Am J Perinatol. 1998 Jan;15(1):57-62. doi: 10.1055/s-2007-993900.
The objective of this paper is to determine whether acyclovir suppression provides a greater cost savings over no medical therapy in the management of recurrent genital herpes (HSV) in pregnancy. Estimates of the risk of HSV recurrence and cesarean delivery rates in acyclovir-treated and -untreated patients and frequency of neonatal acyclovir treatment were derived from literature reviews, prospective surveillance, and practices at our institution. Estimates of costs were derived from average hospital and outpatient clinic charges at our institution. Calculations were run separately for four different groups of patients: women whose first diagnosis of genital herpes occurred during the pregnancy, women whose diagnosis antedated pregnancy and who had infrequent recurrences, women whose diagnosis antedated pregnancy and had frequent recurrences, and all women with a history of genital herpes regardless of timing of diagnosis or frequency of recurrences. Suppressive acyclovir treatment of all term pregnant women with a history of genital herpes resulted in an estimated savings of $183.00 per patient or $36,600,000 per year. Women with their first episode of herpes diagnosed during pregnancy or with frequent recurrences benefitted even more, achieving a savings of $455.00 and $391.00 per patient, respectively. Assuming that prenatal acyclovir treatment is safe for the fetus, utilizing this management for all patients with recurrent HSV in pregnancy could immediately save $183 per patient. On a national level, this translates to $36,600,000 per year just in reduced obstetrical costs. If indirect costs associated with cesarean deliveries had been included in these calculations, the estimated savings would be even more substantial.
本文的目的是确定在妊娠期复发性生殖器疱疹（HSV）的管理中，与不进行药物治疗相比，阿昔洛韦抑制疗法是否能节省更多成本。阿昔洛韦治疗组和未治疗组的HSV复发风险、剖宫产率估计值以及新生儿阿昔洛韦治疗频率是通过文献综述、前瞻性监测以及我们机构的实践得出的。成本估计值来自我们机构的平均医院和门诊费用。针对四组不同患者分别进行了计算：孕期首次诊断为生殖器疱疹的女性、妊娠前诊断且复发频率低的女性、妊娠前诊断且复发频繁的女性，以及所有有生殖器疱疹病史的女性，无论诊断时间或复发频率如何。对所有有生殖器疱疹病史的足月孕妇进行阿昔洛韦抑制治疗，估计每位患者可节省183美元，即每年节省3660万美元。孕期首次发作疱疹或复发频繁的女性受益更多，每位患者分别节省455美元和391美元。假设产前阿昔洛韦治疗对胎儿安全，对所有妊娠期复发性HSV患者采用这种管理方法，每位患者可立即节省183美元。在全国范围内，仅降低产科成本这一项，每年就可节省3660万美元。如果这些计算中纳入了与剖宫产相关的间接成本，估计节省的费用会更多。
