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A Geographically Weighted Cost-effectiveness Analysis of Newborn Cytomegalovirus Screening
Paul M Lantos1,2, Soren Gantt3, Mark Janko2
1Divisions of Pediatric Infectious Diseases, General Internal Medicine, and Occupational and Environmental Medicine, School of Medicine, Duke University, Durham, North Carolina, USA.
Insights
Universal screening for congenital cytomegalovirus (CMV) is cost-effective for all newborns, regardless of geographic location or prevalence. This approach is the best strategy for preventing hearing loss and other severe outcomes in infants with congenital CMV.
Area of Science:
- Neonatal screening
- Public health
- Epidemiology
Background:
- Early identification of congenital cytomegalovirus (CMV) is crucial for timely intervention.
- Universal newborn screening is considered cost-effective, but its economic viability in low-prevalence areas is debated.
- Geographic variations in CMV prevalence may impact screening cost-effectiveness.
Purpose of the Study:
- To analyze the geographic heterogeneity in the cost-effectiveness of universal newborn CMV screening.
- To combine geospatial analysis with existing cost-effectiveness models for CMV screening.
Main Methods:
- Utilized CMV testing results and zip code data from 96,785 newborns across 7 metropolitan areas.
- Employed a hierarchical Bayesian generalized additive model to assess geographic variability in CMV odds.
- Integrated zip code-level CMV odds into a cost-effectiveness model comparing universal vs. targeted screening.
Main Results:
- Significant geographic variation in CMV odds was observed, with higher prevalence in the southeastern US.
- Universal screening proved more cost-effective and averted more cases of severe hearing loss than targeted screening.
- Universal screening remained the most cost-effective strategy even in regions with the lowest CMV prevalence.
Conclusions:
- Universal newborn CMV screening is a cost-effective strategy irrespective of CMV prevalence.
- Universal screening is the preferred method for reducing congenital CMV-related morbidity.
- This approach is recommended for all newborns to improve long-term health outcomes.
Background:
Early identification of newborns with congenital cytomegalovirus (CMV) is necessary to provide antiviral therapy and other interventions that can improve outcomes. Prior research demonstrates that universal newborn CMV screening would be the most cost-effective approach to identifying newborns who are infected. CMV is not uniformly prevalent, and it is uncertain whether universal screening would remain cost-effective in lower-prevalence neighborhoods. Our aim was to identify geographic heterogeneity in the cost-effectiveness of universal newborn CMV screening by combining a geospatial analysis with a preexisting cost-effectiveness analysis.
Methods:
This study used the CMV testing results and zip code location data of 96 785 newborns in 7 metropolitan areas who had been tested for CMV as part of the CMV and Hearing Multicenter Screening study. A hierarchical bayesian generalized additive model was constructed to evaluate geographic variability in the odds of CMV. The zip code-level odds of CMV were then used to weight the results of a previously published model evaluating universal CMV screening vs symptom-targeted screening.
Results:
The odds of CMV were heterogeneous over large geographic scales, with the highest odds in the southeastern United States. Universal screening was more cost-effective and afforded more averted cases of severe hearing loss than targeted testing. Universal screening remained the most cost-effective option even in areas with the lowest CMV prevalence.
Conclusions:
Universal newborn CMV screening is cost-effective regardless of underlying CMV prevalence and is the preferred strategy to reduce morbidity from congenital CMV.
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