Cost-effectiveness analysis of herpes simplex virus testing and treatment strategies in febrile neonates

被引:31
作者
Caviness, A. Chantal [1 ]
Demmler, Gail J. [2 ,3 ]
Swint, J. Michael [4 ]
Cantor, Scott B. [5 ]
机构
[1] Texas Childrens Hosp, Sect Pediat Emergency Med, Houston, TX 77030 USA
[2] Baylor Coll Med, Infect Dis Sect, Dept Pediat, Houston, TX 77030 USA
[3] Texas Childrens Hosp, Diagnost Virol Lab, Houston, TX 77030 USA
[4] Univ Texas Houston, Sch Publ Hlth, Div Management Policy & Community Hlth, Houston, TX 77025 USA
[5] Univ Texas MD Anderson Canc Ctr, Sect Hlth Serv Res, Dept Biostat, Houston, TX 77030 USA
来源
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE | 2008年 / 162卷 / 07期
关键词
D O I
10.1001/archpedi.162.7.665
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objective: To determine the clinical effectiveness and cost-effectiveness of testing for and empirically treating herpes simplex virus (HSV) infection in neonates with fever aged from birth to 28 days. Design: Cost-effectiveness analysis. Setting: Decision model. Patients: Neonates with fever with no other symptoms and neonates with fever with cerebrospinal fluid (CSF) pleocytosis. Interventions: Four clinical strategies: (1) HSV testing and empirical treatment while awaiting test results; (2) HSV testing and treatment if test results were positive for HSV or the patient had symptoms of HSV; (3) treatment alone without testing; or (4) no HSV testing or treatment unless the patient exhibited symptoms. The 2 HSV testing methods used were CSF HSV polymerase chain reaction (PCR) and comprehensive evaluation with blood HSV PCR, CSF HSV PCR, and multiple viral cultures. Main Outcome Measures: Twelve-month survival and quality-adjusted life expectancy with a cost-effectiveness threshold of $100 000 per quality-adjusted life year (QALY) gained. Results: Clinical strategy 1, when applied in febrile neonates with CSF pleocytosis, saved 17 lives per 10 000 neonates and was cost-effective using CSF HSV PCR testing ($55 652/QALY gained). The cost-effectiveness of applying clinical strategy 1 in all febrile neonates depended on the cost of the CSF HSV PCR, prevalence of disease, and parental preferences for neurodevelopmental outcomes. Clinical strategies using comprehensive HSV testing were not cost-effective in febrile neonates ($368 411/QALY gained) or febrile neonates with CSF pleocytosis ($ 110 190/QALY gained). Conclusions: Testing with CSF HSV PCR and empirically treating with acyclovir sodium saves lives and is cost-effective in febrile neonates with CSF pleocytosis. It is not a cost-effective use of health care resources in all febrile neonates.
引用
收藏
页码:665 / 674
页数:10
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