Management of the presumed susceptible varicella (chickenpox)-exposed gravida: A cost-effectiveness / cost-benefit analysis*

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Objective

To compare the cost-effectiveness and cost-benefit of different strategies for managing the presumed susceptible varicella (chickenpox)-exposed gravida.

Methods

Three strategies were evaluated: 1) a do-nothing or observation strategy; 2) a testing strategy, in which immune status was assessed and varicella-zoster immune globulin was administered to those who tested nonimmune; and 3) a universal-administration strategy, in which varicella-zoster immune globulin was given to all exposed, presumed susceptible gravidas. Because precise data are unavailable about varicella mortality and hospitalization rates in pregnancy, a range of potential rates was evaluated, from one to greater than 20 times healthy nonpregnant adult rates. The potential efficacy of varicella-zoster immune globulin varied from 1 to 99%. A strategy was defined as cost-effective if it cost less than $50,000 per life-year gained.

Results

If the mortality rate from varicella infection in pregnancy was increased fivefold over the nonpregnant healthy adult rate (ie, from 31/100,000 to 155/100,000 cases), efficacy would have to be at least 49% for the immunetesting strategy to be cost-effective. If pregnancy only doubled the varicella mortality rate, then even with perfect efficacy, the immune-testing strategy would not be cost-effective. Under most assumptions, the universaladministration strategy was cost-ineffective when compared with the immune-testing strategy. Similar results were obtained in the parallel cost-benefit analysis, which considered hospitalization costs and rates. The analysis was sensitive to the varicella transmission rate and the discount rate.

Conclusion

From a cost-effectiveness/cost-benefit standpoint, management based on immune testing is preferable to universal varicella-zoster immune globulin administration when caring for the varicella-exposed gravida with a negative or indeterminate infection history.

References (25)

  • National Center for Health and Statistics
  • GershonAA et al.

    Antibody to varicella-zoster virus in parturient women and their offspring during the first year of life

    Pediatrics

    (1976)
  • OstroveJM et al.

    The biology of varicella-zoster virus

  • PrebludSR

    Varicella: Complications and costs

    Pediatrics

    (1986)
  • StagnoS et al.

    Herpes virus infections of pregnancy. Part II: Herpes simplex virus and varicella-zoster virus infections

    N Engl J Med

    (1985)
  • PearsonHE

    Parturition varicella-zoster

    Obstet Gynecol

    (1964)
  • SiegelM et al.

    Comparative fetal mortality in maternal virus diseases. A prospective study on rubella, measles mumps, chicken pox and hepatitis

    N Engl J Med

    (1966)
  • ParyaniSG et al.

    Intrauterine infection with varicella-zoster virus after maternal varicella

    N Engl J Med

    (1986)
  • Immunization Practices Advisory Committee (ACIP)

    Varicellazoster immune globulin for the prevention of chickenpox

    MMWR

    (1984)
    Immunization Practices Advisory Committee (ACIP)

    Varicellazoster immune globulin for the prevention of chickenpox

    MMWR

    (1984)
  • McGregorJA et al.

    Varicella-zoster antibody testing in the care of pregnant women exposed to varicella

    Am J Obstet Gynecol

    (1987)
  • EckmanMH et al.

    Foot infections in diabetic patients

    JAMA

    (1995)
  • LawM

    The health service and personal costs of screening

    J Med Screen

    (1995)
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    Supported in part by the Agency for Health Care Policy Research, contract no. DHHS 282-92-0055.

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