Previous literature has shown acyclovir to be cost-effective as prophylaxis for women with genital symptomatic herpes simplex virus infection recurrence during pregnancy. We extend this analysis by adding quality-adju...Previous literature has shown acyclovir to be cost-effective as prophylaxis for women with genital symptomatic herpes simplex virus infection recurrence during pregnancy. We extend this analysis by adding quality-adjusted life year measurements and considering women with a diagnosed history of herpes simplex virus infection but without recurrence in pregnancy. Study design: A decision analytic model was designed that compared acyclovir prophylaxis versus no acyclovir for women with a history of diagnosed genital herpes simplex virus infection but without recurrence in pregnancy. Sensitivity analysis and Monte Carlo simulations were performed to test for robustness. Results: We found that 22,286 women must be treated to prevent 1 neonatal death, 8985 women to prevent 1 affected child, and 177 women to prevent 1 cesarean delivery. As compared with no acyclovir, acyclovir prophylaxis at 36 weeks of gestation saves approximately ＄ 20 per person and increases total quality-adjusted life years by 0.01. In univariate sensitivity analysis, this result was robust to all reasonable probability and quality-adjusted life year estimates. Monte Carlo simulation demonstrated acyclovir to be cost-effective 100% of the time and cost saving >99% of the time. Conclusion: Acyclovir prophylaxis versus no treatment for pregnant women with a diagnosed history of genital herpes simplex virus infection but without recurrence during pregnancy is cost-effective over a wide range of assumptions.展开更多
Objectives: To evaluate the feasibility of a serologic screening program in pregnant women to detect neonates at risk for a congenital cytomegalovirus infection.Study design: Unselected mother-infant pairs (n = 7140) ...Objectives: To evaluate the feasibility of a serologic screening program in pregnant women to detect neonates at risk for a congenital cytomegalovirus infection.Study design: Unselected mother-infant pairs (n = 7140) were studied.In the mother, serologic screening consisted of the testing for cytomegalovirus antibodies at the first prenatal visit and at birth.In the neonate, cytomegalovirus urine culture was performed to diagnose congenital infection.Results: Serologic screening showed evidence of past infection in 3850 women (53.9%); 192 (2.7%) women had both immunoglobulin (Ig)G and IgM antibodies when first tested during pregnancy.Seroconversion was detected in 44 seronegative women (1.4%).Forty-four congenital infections were diagnosed (0.62%): 8 in women with past infections, 22 in women who seroconverted, and 14 in women who initially had positive IgM antibodies.Conclusions: Screening at the first prenatal visit and at birth defines two major risk groups for congenital cytomegalovirusinfection: women with seroconversion during pregnancy and women with IgM antibodies in their first prenatal serum sample (0.6%and 2.7%, respectively, of the pregnant population).In these selected babies (3.3%of the study group), cytomegalovirus urine culture should be performed.This type of screening allows the detection of 82%of all congenital cytomegalovirus infections.展开更多
文摘Previous literature has shown acyclovir to be cost-effective as prophylaxis for women with genital symptomatic herpes simplex virus infection recurrence during pregnancy. We extend this analysis by adding quality-adjusted life year measurements and considering women with a diagnosed history of herpes simplex virus infection but without recurrence in pregnancy. Study design: A decision analytic model was designed that compared acyclovir prophylaxis versus no acyclovir for women with a history of diagnosed genital herpes simplex virus infection but without recurrence in pregnancy. Sensitivity analysis and Monte Carlo simulations were performed to test for robustness. Results: We found that 22,286 women must be treated to prevent 1 neonatal death, 8985 women to prevent 1 affected child, and 177 women to prevent 1 cesarean delivery. As compared with no acyclovir, acyclovir prophylaxis at 36 weeks of gestation saves approximately ＄ 20 per person and increases total quality-adjusted life years by 0.01. In univariate sensitivity analysis, this result was robust to all reasonable probability and quality-adjusted life year estimates. Monte Carlo simulation demonstrated acyclovir to be cost-effective 100% of the time and cost saving >99% of the time. Conclusion: Acyclovir prophylaxis versus no treatment for pregnant women with a diagnosed history of genital herpes simplex virus infection but without recurrence during pregnancy is cost-effective over a wide range of assumptions.
文摘Objectives: To evaluate the feasibility of a serologic screening program in pregnant women to detect neonates at risk for a congenital cytomegalovirus infection.Study design: Unselected mother-infant pairs (n = 7140) were studied.In the mother, serologic screening consisted of the testing for cytomegalovirus antibodies at the first prenatal visit and at birth.In the neonate, cytomegalovirus urine culture was performed to diagnose congenital infection.Results: Serologic screening showed evidence of past infection in 3850 women (53.9%); 192 (2.7%) women had both immunoglobulin (Ig)G and IgM antibodies when first tested during pregnancy.Seroconversion was detected in 44 seronegative women (1.4%).Forty-four congenital infections were diagnosed (0.62%): 8 in women with past infections, 22 in women who seroconverted, and 14 in women who initially had positive IgM antibodies.Conclusions: Screening at the first prenatal visit and at birth defines two major risk groups for congenital cytomegalovirusinfection: women with seroconversion during pregnancy and women with IgM antibodies in their first prenatal serum sample (0.6%and 2.7%, respectively, of the pregnant population).In these selected babies (3.3%of the study group), cytomegalovirus urine culture should be performed.This type of screening allows the detection of 82%of all congenital cytomegalovirus infections.
