Cost-effectiveness of herpes simplex virus type 2 serologic testing and antiviral therapy in pregnancy

Am J Obstet Gynecol. 2004 Dec;191(6):2074-84. doi: 10.1016/j.ajog.2004.05.034.


Objective: The purpose of this study was to determine whether serologic testing for herpes simplex virus type 2 (HSV-2) in pregnant women and their partners is cost-effective.

Study design: A decision analysis model was developed to investigate the cost-effectiveness of providing type-specific serologic testing at week 15 of pregnancy for all women unaware of their HSV-2 status, and offering antiviral suppressive therapy from week 36 until delivery to all seropositive women. This scenario was compared with current care, in which only a minority of women diagnosed with genital herpes (GH) receives antiviral suppressive therapy (AST). In a third scenario, testing is offered to partners of pregnant women who test seronegative, and antiviral suppressive therapy is offered to the partners who test seropositive.

Results: Compared with current care, offering testing and antiviral suppressive therapy to 100,000 pregnant women resulted in an incremental cost of $3.1 million, 15.7 fewer cases of neonatal herpes, 186 fewer cesarean deliveries, and an incremental cost per quality-adjusted life- year gained (QALY) of $18,680. Offering testing and suppressive therapy to both the pregnant women and their partners resulted in an increased cost of $8.6 million, 16.8 fewer cases of neonatal herpes, 192 fewer cesarean deliveries, and an incremental cost per QALY of $48,946 compared with no testing.

Conclusion: Compared with commonly accepted benchmarks for cost-effectiveness (<$50,000/QALY), type-specific HSV-2 serologic testing of pregnant women may be a cost-effective strategy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antiviral Agents / economics*
  • Antiviral Agents / therapeutic use
  • Cohort Studies
  • Cost-Benefit Analysis
  • Decision Support Techniques*
  • Female
  • Herpes Genitalis / diagnosis
  • Herpes Genitalis / drug therapy*
  • Herpes Genitalis / economics*
  • Herpesvirus 2, Human / isolation & purification
  • Humans
  • Pregnancy
  • Pregnancy Complications, Infectious / diagnosis
  • Pregnancy Complications, Infectious / drug therapy*
  • Pregnancy Complications, Infectious / economics*
  • Prenatal Care
  • Risk Assessment
  • Sensitivity and Specificity
  • Serologic Tests / economics
  • United States


  • Antiviral Agents