Leaning towards Cytomegalovirus serological screening in pregnancy to prevent congenital infection: a cost-effectiveness perspective.
BJOG
; 129(2): 301-312, 2022 Jan.
Article
en En
| MEDLINE
| ID: mdl-34651405
ABSTRACT
OBJECTIVE:
To assess the cost-effectiveness of prenatal detection of congenital cytomegalovirus (cCMV) following maternal primary infection in the first trimester within standard pregnancy follow-up or involving population-based screening (serological testing at 7 and 12 weeks of gestation), with or without secondary prevention (valaciclovir) in maternal CMV primary infection.DESIGN:
Cost-effectiveness study from the perspective of the French national health insurance system.SETTING:
Cost-effectiveness based on previously published probability estimates and associated plausible ranges hypothetical population of 1,000,000 pregnant women. POPULATION Hypothetical population of 1,000,000 pregnant women.METHODS:
Cost-effectiveness of detecting fetal cCMV in terms of the total direct medical costs involved and associated expected outcomes. MAIN OUTCOMEMEASURES:
Detection rates and clinical outcomes at birth.RESULTS:
Moving to a population-based approach for targeting fetal CMV infections would generate high monetary and organizational costs while increasing detection rates from 15% to 94%. This resource allocation would help implementing horizontal equity according to which individuals with similar medical needs should be treated equally. Secondary prevention with valaciclovir had a significant effect on maternal-fetal CMV transmission and clinical outcomes in newborns, with a 58% decrease of severely infected newborns for a 3.5% additional total costs. Accounting for women decision-making (amniocentesis uptake and termination of pregnancy in severe cases) did not impact the cost-effectiveness results.CONCLUSIONS:
These findings could fuel thinking on the opportunity of developing clinical guidelines to rule identification of cCMV infection and administration of in-utero treatment. These findings could fuel the development of clinical guidelines on the identification of congenital CMV infection and the administration of treatment in utero. TWEETABLE ABSTRACT CMV serological screening followed by valaciclovir prevention may prevent 58% to 71% of severe cCMV cases for 38 per pregnancy.Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Complicaciones Infecciosas del Embarazo
/
Diagnóstico Prenatal
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Infecciones por Citomegalovirus
Tipo de estudio:
Diagnostic_studies
/
Guideline
/
Health_economic_evaluation
/
Prognostic_studies
/
Screening_studies
País/Región como asunto:
Europa
Idioma:
En
Revista:
BJOG
Asunto de la revista:
GINECOLOGIA
/
OBSTETRICIA
Año:
2022
Tipo del documento:
Article