Valacyclovir Prophylaxis Cheapest Route for Prevention


CHARLESTON, S.C. — Oral valacyclovir was the most economically favorable treatment choice for the prevention of intrapartum herpes transmission in a recent analysis.

The clinical outcomes and costs of the three strategies, including oral valacyclovir, oral acyclovir, and no prophylaxis, were compared using a decision analysis model in a hypothetical cohort of 1 million women with recurrent herpes infection. All strategies included cesarean section for patients with active lesions during labor, Monique G. Lin, M.D., of the University of Alabama, Birmingham, and her colleagues reported in a poster at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

The valacyclovir model included 500 mg given twice daily beginning at 36 weeks' gestation; the oral acyclovir model included 200 mg given four times daily beginning at 36 weeks' gestation.

The investigators used the literature and “local sources” to determine baseline costs, and based their analysis on current treatment strategies that employ polymerase chain reaction, viral culture, and high-dose intravenous acyclovir for treatment of affected neonates. Using this model, the researchers showed that the total costs in the hypothetical cohort were $9.94 billion for valacyclovir, $9.93 billion for acyclovir, and $13.7 billion for no prophylaxis.

The number of cases of neonatal death or moderate-to-severe neonatal morbidity associated with each treatment in this model was 1,911 with valacyclovir, 2,111 with acyclovir, and 8,240 with no prophylaxis.

The number of cases prevented by using valacyclovir prophylaxis was 6,239, and the number prevented by using acyclovir prophylaxis was 6,129.

The cost per case prevented was $1.57 million for valacyclovir and $1.62 million for acyclovir, the investigators reported at the meeting.

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