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Antiviral therapy for neonatal herpes simplex virus: a cost-effectiveness analysis
S T Mennemeyer1, L P Cyr, R J Whitley
1University of Alabama at Birmingham, School of Public Health 35294-2010, USA.
The American Journal of Managed Care
|September 4, 1997
Summary
Antiviral therapy for neonatal herpes simplex virus (HSV) infection is cost-effective, saving lives and reducing overall costs for skin, ear, and mouth disease. Treatment for CNS and disseminated HSV infections also saves lives, with varying costs per life saved.
Area of Science:
- Neonatal infectious diseases
- Pharmacoeconomics
- Virology
Background:
- Neonatal herpes simplex virus (HSV) infection affects approximately 1,600 infants annually in the U.S.
- HSV can manifest as skin, ear, and mouth (SEM) disease, central nervous system (CNS) disease, or disseminated multiorgan (DIS) disease.
- Untreated neonatal HSV infections have significant morbidity and mortality.
Purpose of the Study:
- To conduct a cost-effectiveness analysis of antiviral drug therapy (acyclovir) for neonatal HSV infection.
- To compare the costs and outcomes of treating different forms of neonatal HSV (SEM, CNS, DIS) versus no treatment.
- To evaluate the cost-effectiveness from both societal and managed care perspectives.
Main Methods:
- Cost-effectiveness analysis comparing antiviral therapy (acyclovir) with no treatment for neonatal HSV.
- Inclusion of five patient outcome levels: normal, mild, moderate, severe, and death.
- Data on disease occurrence and survival obtained from clinical trials and historical reviews.
- Costs measured from societal and managed care perspectives, including direct medical costs, institutional care, and special education.
- Discount rate of 3% and 1995 U.S. dollar values used.
Main Results:
- For SEM disease, antiviral therapy resulted in a gain of 0.8 lives and a cost reduction of $78,601 per case compared to no treatment.
- For CNS and DIS disease, antiviral therapy saved more lives but incurred additional costs, with marginal costs per additional life saved of $75,125 and $46,619, respectively.
- Antiviral therapy is more cost-effective from a managed care perspective due to exclusion of institutional and special education costs.
Conclusions:
- Antiviral therapy, specifically acyclovir, is a cost-effective intervention for neonatal herpes simplex virus infection.
- The cost-effectiveness varies by disease manifestation (SEM, CNS, DIS), with SEM being cost-saving.
- Managed care organizations benefit more from antiviral therapy due to cost-sharing structures, and future at-home therapies may further enhance cost-effectiveness.