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Cost-effectiveness analysis of herpes simplex virus testing and treatment strategies in febrile neonates.
Arch Pediatr Adolesc Med. 2008 Jul; 162(7):665-74.AP

Abstract

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.

Authors+Show Affiliations

Texas Children's Hospital, Section of Pediatric Emergency Medicine, 6621 Fannin St, Houston, TX 77030, USA. accavine@texaschildrenshospital.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18606938

Citation

Caviness, A Chantal, et al. "Cost-effectiveness Analysis of Herpes Simplex Virus Testing and Treatment Strategies in Febrile Neonates." Archives of Pediatrics & Adolescent Medicine, vol. 162, no. 7, 2008, pp. 665-74.
Caviness AC, Demmler GJ, Swint JM, et al. Cost-effectiveness analysis of herpes simplex virus testing and treatment strategies in febrile neonates. Arch Pediatr Adolesc Med. 2008;162(7):665-74.
Caviness, A. C., Demmler, G. J., Swint, J. M., & Cantor, S. B. (2008). Cost-effectiveness analysis of herpes simplex virus testing and treatment strategies in febrile neonates. Archives of Pediatrics & Adolescent Medicine, 162(7), 665-74. https://doi.org/10.1001/archpedi.162.7.665
Caviness AC, et al. Cost-effectiveness Analysis of Herpes Simplex Virus Testing and Treatment Strategies in Febrile Neonates. Arch Pediatr Adolesc Med. 2008;162(7):665-74. PubMed PMID: 18606938.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness analysis of herpes simplex virus testing and treatment strategies in febrile neonates. AU - Caviness,A Chantal, AU - Demmler,Gail J, AU - Swint,J Michael, AU - Cantor,Scott B, PY - 2008/7/9/pubmed PY - 2008/8/6/medline PY - 2008/7/9/entrez SP - 665 EP - 74 JF - Archives of pediatrics & adolescent medicine JO - Arch Pediatr Adolesc Med VL - 162 IS - 7 N2 - 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. SN - 1538-3628 UR - https://www.unboundmedicine.com/medline/citation/18606938/Cost_effectiveness_analysis_of_herpes_simplex_virus_testing_and_treatment_strategies_in_febrile_neonates_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/archpedi.162.7.665 DB - PRIME DP - Unbound Medicine ER -