COST-EFFECTIVENESS OF ROUTINE ANTENATAL VARICELLA SCREENING

Objective: To evaluate the cost-effectiveness of routine antenatal var icella serologic screening of pregnant women with negative or indeterm inate varicella histories. Methods: Routine antenatal varicella screen ing was evaluated using a decision analytic model. Outcomes were varic ella cases, deaths, and life-years. Probabilities were derived from th e literature, and sensitivity analysis was performed when data were im precise or subject to variation. The analysis was repeated to include the effect of a policy of routine screening and vaccination of all adu lts. Results: Routine antenatal varicella screening of history-negativ e women was not cost-effective unless the cost of screening was decrea sed 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 n ot sensitive to alterations in varicella-zoster immunoglobulin (Ig) ef fectiveness, varicella communicability, rates and timing of contact re porting, costs (per case, pneumonia, and death), or serologic test per formance. If performed as part of a policy of universal screening of a ll history-negative adults (with vaccination of the majority of those testing nonimmune), routine antenatal varicella testing became cost-ef fective. Conclusion: Routine antenatal varicella screening of all preg nant women with negative or indeterminate varicella histories is not c ost-effective. It could be cost-effective in groups of women with incr eased exposure risk, or if part of a policy of screening and vaccinati on of all adults. (C) 1998 by The American College of Obstetricians an d Gynecologists.