The high cost and low efficacy of weekly viral cultures for pregnant women with recurrent genital herpes: a reappraisal.

The use of weekly cultures to prevent neonatal infection among infants of pregnant women who have histories of genital herpes has been controversial since a decision analysis study in 1983 suggested that this strategy was not cost-effective and would avert relatively few cases of neonatal herpes simplex virus infection. Using more recent and better data, the authors reanalyzed this approach to reducing neonatal herpes infection. The reanalysis revealed that a national screening program would prevent only 1.8 cases of neonatal herpes in the United States annually, at a cost of more than 37 million dollars per case averted. The program would cost nearly 7 million dollars per quality-adjusted life year gained when only infant deaths are taken into consideration. When maternal deaths from excess cesarean deliveries are taken into account, over 44 million dollars would be spent for every quality-adjusted life-year gained. On the basis of the strategy's limited benefits and low cost-effectiveness, the authors support the American College of Obstetrics and Gynecology's position of abandoning the recommendation for weekly prenatal herpes cultures.