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The cost-effectiveness of neonatal versus prenatal screening for congenital toxoplasmosis
Christine Binquet1,2, Catherine Lejeune1,2, Valérie Seror3,4
1INSERM, CIC1432, Module Epidémiologie Clinique, Dijon, France.
Insights
Prenatal screening for congenital toxoplasmosis (CT) is more cost-effective than neonatal screening, especially in areas with moderate prevalence. This approach aids in educating at-risk pregnant women and preventing severe outcomes in newborns.
Area of Science:
- Medical economics
- Public health policy
- Infectious disease epidemiology
Background:
- Congenital toxoplasmosis (CT) poses significant health risks, prompting screening programs in several European countries.
- Debate exists regarding the efficiency of current screening programs due to declining seroprevalence and incidence rates.
- Uncertainty persists regarding the long-term effectiveness of both prenatal and postnatal treatments for CT.
Purpose of the Study:
- To compare the cost-effectiveness of prenatal versus neonatal screening strategies for congenital toxoplasmosis.
- To inform public health policy decisions regarding optimal screening approaches for CT.
Main Methods:
- A decision-analytic model was employed, utilizing French guidelines and data from the French Lyon cohort.
- Epidemiological and clinical data were sourced from scientific literature and cohort studies.
- Cost-effectiveness was evaluated from the French Health Insurance System perspective at 1-year and 15-year endpoints.
Main Results:
- Prenatal screening incurs an additional cost of €14,826 per adverse event avoided compared to neonatal screening at 1 year.
- This incremental cost rises to €21,472 when considering a 15-year time horizon.
- The analysis considered direct medical costs for pregnant women and affected children.
Conclusions:
- Prenatal screening is a cost-effective strategy compared to neonatal screening in regions with moderate CT prevalence and predominantly Type II strains.
- Prenatal screening facilitates enhanced follow-up and educational opportunities for women at risk.
- This approach can contribute to reducing the incidence and severity of congenital toxoplasmosis.
Background:
Congenital Toxoplasmosis (CT) can have severe consequences. France, Austria, and Slovenia have prenatal screening programs whereas some other countries are considering universal screening to reduce congenital transmission and severity of infection in children. The efficiency of such programs is debated increasingly as seroprevalence among pregnant women and incidence of congenital toxoplasmosis show a steady decrease. In addition, uncertainty remains regarding the effectiveness of pre- and postnatal treatments.
Method:
To identify cost-effective strategies, prenatal and neonatal screenings were compared using a decision-analytic model based on French guidelines and current knowledge of long-term evolution of the disease in treated children. Epidemiological data were extracted from the scientific literature and clinical data from the French Lyon cohort. Strategies were compared at one year of age, when infection can be definitively evaluated, and at 15 years of age, after which validated outcome data become scarce. The analysis was performed from the French Health Insurance System perspective and included direct medical costs for pregnant women and their children.
Results:
The 1-year Incremental Cost-Effectiveness Ratio showed that prenatal screening would require investing €14,826 to avoid one adverse event (liveborn with CT, fetal loss, neonatal death or pregnancy termination) compared to neonatal screening. Extra investment increased up to €21,472 when considering the 15-year endpoint.
Conclusions:
Prenatal screening is cost-effective as compared to neonatal screening in moderate prevalence areas with predominant Type II strains. In addition, prenatal screening, by providing closer follow-up of women at risk increases the number of occasions for education avoiding toxoplasmosis.
