Cost-effectiveness of routine antenatal varicella screening

Obstet Gynecol. 1998 Apr;91(4):519-28. doi: 10.1016/s0029-7844(98)00030-1.


Objective: To evaluate the cost-effectiveness of routine antenatal varicella serologic screening of pregnant women with negative or indeterminate varicella histories.

Methods: Routine antenatal varicella screening was evaluated using a decision analytic model. Outcomes were varicella cases, deaths, and life-years. Probabilities were derived from the literature, and sensitivity analysis was performed when data were imprecise or subject to variation. The analysis was repeated to include the effect of a policy of routine screening and vaccination of all adults.

Results: Routine antenatal varicella screening of history-negative women was not cost-effective unless the cost of screening was decreased six-fold, varicella exposure rates were greater than 6%, or there was a greater than three-fold decrease in varicella exposure in women testing nonimmune compared with unscreened women. These results were not sensitive to alterations in varicella-zoster immunoglobulin (Ig) effectiveness, varicella communicability, rates and timing of contact reporting, costs (per case, pneumonia, and death), or serologic test performance. If performed as part of a policy of universal screening of all history-negative adults (with vaccination of the majority of those testing nonimmune), routine antenatal varicella testing became cost-effective.

Conclusion: Routine antenatal varicella screening of all pregnant women with negative or indeterminate varicella histories is not cost-effective. It could be cost-effective in groups of women with increased exposure risk, or if part of a policy of screening and vaccination of all adults.

MeSH terms

  • Adult
  • Antibodies, Viral / analysis
  • Chickenpox / economics
  • Chickenpox / immunology
  • Chickenpox / prevention & control*
  • Cost-Benefit Analysis
  • Decision Support Techniques*
  • Female
  • Herpesvirus 3, Human / immunology
  • Humans
  • Immunoglobulins
  • Mass Screening / economics*
  • Pregnancy
  • Pregnancy Complications, Infectious / economics
  • Pregnancy Complications, Infectious / immunology
  • Pregnancy Complications, Infectious / prevention & control*
  • Sensitivity and Specificity


  • Antibodies, Viral
  • Immunoglobulins