Antiviral therapy for neonatal herpes simplex virus: a cost-effectiveness analysis

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.