PREVENTION OF CHICKENPOX IN REPRODUCTIVE-AGE WOMEN - COST-EFFECTIVENESS OF ROUTINE PRENATAL SCREENING WITH POSTPARTUM VACCINATION OF SUSCEPTIBLES

Objective: To evaluate economic and clinical outcomes of a program of routine prenatal serotesting for variceila and postpartum vaccination of seronegative women. Methods: An analytic cost-effectiveness model w as constructed to compare the current strategy of no serotesting with 1) selective serotesting of pregnant women without a prior history of chickenpox and 2) serotesting of all pregnant women. In both serotesti ng strategies, seronegative women were vaccinated postpartum The model followed a hypothetical cohort of 4 million women over 20 years. Cost s and chickenpox disease outcomes during and outside of subsequent pre gnancies were considered. The incremental cost-effectiveness (cost per adult chickenpox case prevented) of selective serotesting compared wi th the current strategy was measured. Results: Compared to no testing, selective serotesting would prevent 43% (48,577 of 112,654) of adult chickenpox cases, save $21.8 million in discounted medical and work lo ss costs from the societal perspective, and cost $1126 per case preven ted from the health payer's perspective (medical costs only). The mode l was sensitive to varicella seroprevalence and incidence of chickenpo x among susceptible women but was relatively insensitive to the cost o f serologic testing and vaccination. Compared with selective serotesti ng, the serotest-all strategy would prevent an additional 15,645 cases , at a societal cost of $7653 per additional case prevented. Conclusio n: The selective serotesting strategy could prevent nearly half of chi ckenpox cases among this cohort and is cost-saving from the societal p erspective. From the health payer's perspective, it compares favorably with other generally accepted preventive practices. It should be cons idered for prevention of chickenpox among women of childbearing age. ( Obstet Gynecol 1998;92:535-45. (C) 1998 by The American College of Obs tetricians and Gynecologists.).