Table 2.

Key gaps to be addressed related to model-based estimates of HSV costs.

Costs	Summary of existing or planned models/estimates	Major gaps/new modelling efforts needed	Key new data needs	Important considerations
HSV-2 infection	A few national estimates of direct annual costs of diagnosing and treating HSV-2 exist for US Lifetime cost-per-case estimate in US (for diagnosis/treatment) One estimate of indirect costs Main estimates do not include costs of neonatal herpes nor HSV-associated HIV and use older cost data (2000 or before) No aggregate annual cost nor lifetime cost-per-case estimates found for other countries Many itemized cost components available in HICs, e.g., for HSV testing, counseling, suppressive therapy, clinician visits	Estimates of costs, both aggregate annual and lifetime cost-per-case, outside the US, especially LMICs Cost estimates that incorporate neonatal herpes and HSV-associated HIV infection Updated cost estimates, using current data on HSV testing, antiviral use, other measures	Review of HSV care and treatment costs, especially in LMICs Review of care-seeking, health care utilization, testing practices in different settings for HSV disease, especially in LMICs Utilization rates of episodic and chronic suppressive therapy for HSV in HICs and LMICs	Use of multiple data sources, including administrative or claims data, where possible Explore validated healthcare costs in LMICs for similar conditions Consider time frame, horizon of analysis For LMICs, consider costs that would be incurred if national recommendations followed; treatment may not be used because too expensive, but vaccine may have relatively lower costs to provide standard of care
HSV-1 infection	No identified comprehensive cost estimates	Estimates of costs, aggregate annual and lifetime cost-per-case, in both HICs and LMICs Incorporation of current data on utilization of care and treatment for HSV-1-related outcomes	Better information on HSV-1 disease occurrence and natural history (see Table 1 above) Evaluation of administrative or claims data on oral HSV-1 evaluations and treatment Review oral HSV treatment and administration costs (if different than genital HSV costs above, e.g., topical treatment or over the counter medications)	Consider dentistry/oral medicine literature and collaborators
Neonatal herpes	Estimates of lifetime cost per case of neonatal herpes available for US, but not other countries Estimates vary substantially based on whether long-term disability costs included Neonatal herpes costs not systematically included in US aggregate annual cost estimates Several studies of cost-effectiveness of HSV screening and suppressive therapy in pregnant women Many itemized cost components available in HICs, including acute neonatal herpes hospitalization costs	Aggregate annual and lifetime HSV cost-per-case estimates that include neonatal herpes costs Lifetime cost-per-case estimates for neonatal herpes outside the US, especially LMICs Update neonatal herpes cost estimates using current data on costs, clinical practice, and long-term disability, as well as indirect costs	Better data on risks of neonatal HSV transmission and neonatal herpes incidence in LMICs (see Table 1) Neonatal HSV testing, treatment methods and rates, and other healthcare costs in different settings Better data on long-term outcomes and associated disability costs in all settings	Consider costs of neonatal herpes prevention, including serological testing, suppressive therapy, and Caesarean sections Use of multiple data sources, including administrative or claims data, where possible
HSV-related HIV infection	No specific models of costs pertaining to HSV-related HIV infection, but several models of estimated HIV costs	Aggregate annual and lifetime HSV cost-per-case estimates that include HSV-related HIV infection costs	Updated models of the attributable fraction of HIV due to HSV infection (see Table 1) Review of existing cost estimates for HIV infection	Consider effect of HSV-HIV co-infection on the natural histories of each, and associated costs (e.g., worsening genital ulcer disease, clinical progression of HIV, etc.)