Am J Perinatol 2019; 36(07): 678-687
DOI: 10.1055/s-0038-1676495
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Cytomegalovirus Screening in Pregnancy: A Cost-Effectiveness and Threshold Analysis

Catherine M. Albright
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
,
Erika F. Werner
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Brenna L. Hughes
3   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
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Weitere Informationen

Publikationsverlauf

28. Juni 2018

30. Oktober 2018

Publikationsdatum:
19. Dezember 2018 (online)

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Abstract

Objective To determine threshold cytomegalovirus (CMV) infectious rates and treatment effectiveness to make universal prenatal CMV screening cost-effective.

Study Design Decision analysis comparing cost-effectiveness of two strategies for the prevention and treatment of congenital CMV: universal prenatal serum screening and routine, risk-based screening. The base case assumptions were a probability of primary CMV of 1% in seronegative women, hyperimmune globulin (HIG) effectiveness of 0%, and behavioral intervention effectiveness of 85%. Screen-positive women received monthly HIG and screen-negative women received behavioral counseling to decrease CMV seroconversion. The primary outcome was the cost per maternal quality-adjusted life year (QALY) gained with a willingness to pay of $100,000 per QALY.

Results In the base case, universal screening is cost-effective, costing $84,773 per maternal QALY gained. In sensitivity analyses, universal screening is cost-effective only at a primary CMV incidence of more than 0.89% and behavioral intervention effectiveness of more than 75%. If HIG is 30% effective, primary CMV incidence can be 0.82% for universal screening to be cost-effective.

Conclusion The cost-effectiveness of universal maternal screening for CMV is highly dependent on the incidence of primary CMV in pregnancy. If efficacious, HIG and behavioral counseling allow universal screening to be cost-effective at lower primary CMV rates.

Note

This study was presented as a poster at the 2015 Society for Maternal-Fetal Medicine Annual Meeting, February 2–7, 2015, San Diego, CA.