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Efficacy, Risks, and Costs

Adrienne G. Randolph, MD; A. Eugene Washington, MD, MSc; Charles G. Prober, MD

JAMA. 1993;270(1):77-82.

Abstract
Objective.
—To assess the effect of cesarean delivery on neonatal and maternal morbidity and mortality and their associated costs for two populations of women presenting with genital herpes lesions at delivery: those with and those without a history of genital herpes.

Data Sources.
—MEDLINE (search for herpes simplex virus and neonatal, cesarean, and mortality) and recognized experts.

Data Extraction.
—The quality of the overall data used for baseline values was graded using a predetermined scale.

Results.
—The practice of cesarean delivery for women with a history of genital herpes lesions that recur at delivery results in more than 1580 excess cesarean deliveries performed for every poor neonatal outcome prevented, a cost per neonatal herpes case averted of $2.5 million and a cost per quality-adjusted life-year gained of $203 000. For these women, lowering the efficacy of cesarean delivery or the herpes simplex virus vertical transmission rate could result in maternal deaths outnumbering neonatal deaths prevented. In contrast, cesarean delivery for women with no history of genital herpes simplex virus who have lesions at delivery has low maternal costs per neonatal benefit and saves money.

Conclusions.
—Women who present with their first clinical episode of genital herpes at delivery should have a cesarean section performed. However, the current practice of cesarean delivery for women with a history of genital herpes lesions that recur at delivery results in high maternal morbidity and mortality at substantial financial expense, underscoring the urgency of examining alternative management strategies.

(JAMA. 1993;270:77-82)

Author Affiliations
From the Departments of Pediatrics (Dr Randolph), Gynecology, Obstetrics, and Reproductive Sciences (Dr Washington), and the MEDTEP Research Center on Minority Populations, Institute for Health Policy Studies (Drs Randolph and Washington), University of California School of Medicine, San Francisco; and the Department of Pediatrics, Stanford (Calif) University School of Medicine (Dr Prober).

Footnotes
Reprints not available.

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