Prevention of Herpes Simplex Virus Eye Disease

Methods: An economic decision-tree model was used on follow-up data from 703 patients with prior ocular HSV disease who were enrolled in a Herpetic Eye DiseaseStudymulticenterclinicaltrialthatevaluatedtheprolonged use of oral acyclovir. Costs were based on wholesale drug prices, Medicare fees, and national health surveys. Incremental cost-effectiveness ratios for all patients and for patients with prior stromal keratitis were calculated as the additional net cost of acyclovir prophylaxis compared with the number of cases of ocular herpes prevented during 12 months. One- and 2-way sensitivityanalysesevaluatedtheeffectofdifferenttreatment costs and recurrence risks. Results:Approximately$17.7millionisexpendedannually to treat the estimated 59000 new and recurrent episodes of HSV eye disease occurring among 29000 individualseachyearintheUnitedStates.Chronicsuppressive oralacyclovircosts$8532perocularHSVepisodeaverted. The incremental cost per infection averted would decline by up to 51% if antiviral prophylaxis were more effective and by up to 87% if patients had a higher recurrence risk. Targeting prophylaxis to patients with a history of stromalkeratitisisnotmorecost-effectivethanprovidingoral acyclovir for patients with any prior HSV eye disease.