217: Antenatal screening for HSV: The cost-effectiveness of various screening modalities

Abstract

SCREENING MODALITIES SARAH LITTLE, ANJALI KAIMAL, AARON CAUGHEY, Brigham and Women’s Hospital, Boston, Massachusetts, University of California, San Francisco, San Francisco, California OBJECTIVE: To investigate which, if any, antenatal screening program for genital HSV is cost-effective. STUDY DESIGN: A decision analytic model was created in Data TreeAge Pro. Our primary outcome was cost per quality-adjusted life year (QALY) from a societal perspective. 13 screening regimens were compared. (1) Type-specific screening at 35 weeks gestational age with acyclovir suppression if screen positive. (2-12) Screening women and, if negative, their partners, using all combinations of various screening times [15 vs. 35 weeks], screening protocols [HSV-2 only vs. 1 and 2], and therapeutic interventions [counseling vs. counseling plus suppression for women vs. counseling plus suppression for women and their partners]. RESULTS: Table 1 displays the costs, QALYs, incremental cost per QALY and cases of neonatal HSV for no screening as compared to the three most cost-effective screening modalities. Only the limited screening program, where women alone are screened at 35 weeks of gestation for seropositivity to HSV-2 and offered suppressive therapy if screen positive, was robust in sensitivity analysis. CONCLUSION: A limited antenatal screening program may be cost-effective. Caution is advised, however, as even minor considerations for increased falsepositive lesion detection or disutility from a positive screen appear to drastically alter the cost-effectiveness of any HSV screening program.