全球查和瓦拉基克洛维尔治疗第一季度的原发性细胞大脑病毒:一个成本效益分析
Sarah K Dzubay1, Amelia H Gagliuso1, Megha Arora1
1Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR.
American journal of obstetrics and gynecology
|February 13, 2025
概括
在怀孕早期对细胞巨乳病毒 (CMV) 的普遍查是具有成本效益的. 用瓦拉西克洛维尔治疗孕产妇的CMV感染可以预防传播,并减少长期健康问题,节省金钱并改善生活质量.
科学领域:
- 产科和妇科 产科和妇科
- 传染性疾病 传染性疾病
- 公共卫生 公共卫生
背景情况:
- 在美国,由于缺乏有效的干预措施,对细胞巨化病毒 (CMV) 的普世产前查不是标准.
- 新出现的证据表明,在怀孕第一季度用valacyclovir治疗母亲的初级CMV感染可以减少垂直传播.
- 这为普遍查在预防先天性CMV方面发挥了潜在的作用.
研究的目的:
- 评估普遍的第一季度孕产妇CMV查的成本效益.
- 评估后续瓦赛克洛维尔治疗对预防先天性CMV后续的影响.
主要方法:
- 一个决策分析模型模拟了2,869,141次怀孕的结果.
- 通过IgG,IgM和低IgG激烈性测试确定了初级CMV感染.
- 瓦拉西克洛维尔治疗给了阳性病例;结果包括传播,堕胎,死胎,新生儿死亡,听力损失,神经发育障碍,成本和QALYs.
- 灵敏度分析包括龙卷风,无变量和蒙特卡洛模拟.
主要成果:
- 全面查和瓦拉环治疗减少了不良结果,预防了2898例传播,94例堕胎,19例死产,11例新生儿死亡,460例听力损失病例和263例神经发育残疾病例.
- 这种策略占据了主导地位,节省了2.42亿美元,并获得了3437个QALY.
- 敏感性分析证实了成本效益,即使测试特异性降低或查成本增加.
结论:
- 第一个季度对初级CMV的查是一种节省成本的干预措施.
- 早期识别可以治疗,减少垂直CMV传播和相关的长期成本.
- 普遍查是预防先天性CMV的宝贵工具.
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