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A Cost-Effective Analysis of Treatment Strategies for the Control of HSV-2 Infection in the US

Abstract:

Infection of Herpes Simplex Virus type 2 (HSV–2) is a lifelong disease, which is mainly sexually transmitted, causing genital lesions. According to the Center for Disease Control (CDC), prevalence of HSV–2 in 2015-2016 was estimated at 11.9% of the United States (US) population. The HSV–2 pathogen establishes latent infections in neural cells and can reactivate causing lesions later in life. The latent infection establishment mechanism involves a strategy that not only increases pathogenicity of the disease, but also allows the virus to evade the immune system. HSV–2 infections are treated by a standard therapeutic acyclovir, a synthetic acyclic purine-nucleoside analogue typically prescribed to symptomatic chronic patients, typically referred to a non-constitutional stage. The non-constitutional stage exhibits genital skin lesions and ulcers. The constitutional stage expresses mild symptoms such as fever, skin-redness, itching, headache, and painful urination. In this study, we develop and analyze a mathematical model that considers spread of HSV-2 among the population between the ages of 15-49 in the US and used it to design an optimal treatment distribution strategy. The goal of this research is to evaluate the cost effectiveness of (i) treating HSV–2 infected individuals who are in both constitutional and non-constitutional stages versus (ii) the current conventional treatment protocol for treating only the patients in the nonconstitutional stage. Our results distinguish model parameter regimes where each of the two treatment strategy optimizes the available resources and consequently gives the long-term reduced cost associated in effectively handling a patients treatment, while reducing overall incidence. The public health cost of HSV–2 with the newly implemented treatment would increase from $16 billion to $20 billion. By considering the proposed strategy for treatment and comparing it with the conventional treatment, it can be observed that early treatment reduces HSV–2 incidence by 38% yearly. The estimated value of the reproductive number decreases by 40% from 2.5 which is based on current conventional treatment protocol.

 

Year: 2018

Authors:

Luis Almonte-Vega - Universidad de Puerto Rico en Mayaguez

Monica Colon-Vargas - Universidad de Puerto Rico en Mayaguez

Ligia Luna-Jarrın - Instituto Nacional de Investigacion en Salud Publica de Ecuador

Joel Martinez - Southwestern University

Jordy Rodriguez-Rincon - Universidad Nacional de Colombia

Rohan Patil - Arizona State University

Baltazar Espinoza - Arizona State University

Anarina Murillo - University of Alabama at Birmingham 

Leon Arriola - University of Wisconsin, Whitewater

Arunachalam Viswanathan - Universidad Nacional de Colombia

 

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