The cost-effectiveness of routine antenatal screening for maternal herpes simplex virus-1 and -2 antibodies

Objective: The purpose of this study was to determine the cost-effectiveness of routine antenatal screening for herpes simplex virus 1 and 2 in women without a known history of genital herpes. Study design: Decision analysis was used to compare 3 treatment strategies to prevent neonatal herpes infection in women without a known history of genital herpes simplex virus: (1) the current standard of care (no herpes simplex virus screening), (2) antepartum herpes simplex virus-1 and -2 antibody screening of the pregnant woman and her male partner with appropriate counseling, and (3) antepartum herpes simplex virus-1 and -2 antibody screening with appropriate counseling and acyclovir prophylaxis at 36 weeks of gestation in seropositive women. Results: Our model predicts that using current guidelines, 1 of 5469 women will have a herpes-infected neonate. Strategy 2 and 3 cost $5,812,819 and $4,130,297, respectively, for every significant neurologic sequela or death prevented. The cost-effectiveness of these strategies, expressed as cost per quality life-year gained, was $219,513 and $155,988 respectively. These results were robust in the sensitivity analysis. Conclusion: Routine herpes simplex virus screening in pregnancy is not cost-effective.