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.