Universal screening and valacyclovir for first trimester primary cytomegalovirus: a cost-effectiveness analysis

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Public Health

Background:

• Universal prenatal screening for cytomegalovirus (CMV) is not standard in the US due to a lack of effective interventions.
• Emerging evidence suggests treating maternal primary CMV infections in the first trimester with valacyclovir can reduce vertical transmission.
• This creates a potential role for universal screening in preventing congenital CMV.

Purpose of the Study:

• To evaluate the cost-effectiveness of universal first-trimester maternal CMV screening.
• To assess the impact of subsequent valacyclovir treatment on preventing congenital CMV sequelae.

Main Methods:

• A decision-analytic model simulated outcomes for 2,869,141 pregnancies.
• Identified primary CMV infection via IgG, IgM, and low IgG avidity tests.
• Valacyclovir treatment was administered to positive cases; outcomes included transmission, abortions, stillbirths, neonatal deaths, hearing loss, neurodevelopmental disabilities, costs, and QALYs.
• Sensitivity analyses included tornado, univariable, and Monte Carlo simulations.

Main Results:

• Universal screening and valacyclovir treatment decreased adverse outcomes, preventing 2898 transmissions, 94 abortions, 19 stillbirths, 11 neonatal deaths, 460 hearing loss cases, and 263 neurodevelopmental disability cases.
• This strategy was dominant, saving $242.2 million and gaining 3437 QALYs.
• Sensitivity analyses confirmed cost-effectiveness, even with reduced test specificity or increased screening costs.

Conclusions:

• First-trimester screening for primary CMV is a cost-saving intervention.
• Early identification enables treatment, reducing vertical CMV transmission and associated long-term costs.
• Universal screening represents a valuable tool for congenital CMV prevention.