Single-Step Universal First-Trimester Cytomegalovirus Screening and Valacyclovir Prophylaxis in Pregnancy: A...

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Health Economics

Background:

• Congenital cytomegalovirus (cCMV) infection is a leading cause of non-genetic sensorineural hearing loss and cognitive impairment in children.
• Current screening protocols for CMV are often reactive or targeted, missing opportunities for early intervention.

Purpose of the Study:

• To conduct a cost-utility analysis comparing universal first-trimester cytomegalovirus (CMV) serological screening with valacyclovir prophylaxis against routine ultrasound-directed testing.
• To determine the incremental cost-effectiveness ratio (ICER) of universal CMV screening.

Main Methods:

• A payer perspective cost-utility analysis using a decision-tree and Markov model.
• Simulated a hypothetical cohort of 100,000 pregnant women over pregnancy and child's lifetime.
• Assessed quality-adjusted life years (QALYs) gained from preventing cCMV sequelae.

Main Results:

• The ICER for universal screening was $125,864/QALY gained, preventing approximately 54 cCMV infections per 100,000 mothers.
• This strategy averted 18 symptomatic infections and 17 cases of sensorineural hearing loss and cognitive impairment by age 5.
• Key factors influencing cost-effectiveness included valacyclovir efficacy, CMV prevalence, and symptomatic cCMV probability.

Conclusions:

• Universal CMV screening with valacyclovir prophylaxis is a potentially cost-effective strategy, comparable to other antenatal screenings.
• The approach can significantly reduce childhood morbidity associated with cCMV.
• Valacyclovir's effectiveness, CMV prevalence, and symptomatic cCMV risk are critical variables for optimizing the ICER.