Cost‐effectiveness of screening and valacyclovir‐based treatment strategies for first‐trimester cytomegalovirus primary infection in pregnant women in France

Abstract

ObjectiveTo assess effectiveness, cost and cost‐effectiveness of four screening strategies for first‐trimester cytomegalovirus (CMV) primary infection (T1 PI) in pregnant women in France.MethodsWe compared four strategies of screening for CMV during pregnancy in France: no screening (S1), current screening in “real life” (25 to 50% pregnant women) (S2), universal screening (S3) and universal screening associated with valaciclovir in case of T1 PI (S4). Outcomes were total costs, effectiveness (number of congenital infections, number of diagnosed infections) and incremental cost‐effectiveness ratio (ICER). Two ICERs were calculated comparing (1) S1, S2 and S3 in terms of euros per (€/) supplemental diagnosis, and (2) S1 and S4 in €/avoided congenital infection.ResultsCompared to S1, S3 allowed the diagnosis of 536 more infected fetuses and S4 prevented 375 congenital infections. S1 was the least expensive strategy (M€98.3), compared to S4 (M€98.6), S2 (M€106.0) and S3 (M€118.9). In the first analysis, S2 was dominated and S3 led to 38,552€/ in utero supplemental diagnosis, compared to S1. In the second analysis, S4 led to 893€/avoided congenital infection compared to S1, and was cost‐saving compared to S2.ConclusionsIn France, screening for CMV PI during pregnancy as performed in real life is no longer acceptable in terms of cost‐effectiveness because this strategy is dominated by universal screening. Moreover, universal screening associated with valaciclovir would be cost‐effective compared to current recommendations and is cost‐saving compared to “real life”.This article is protected by copyright. All rights reserved.

Consensus recommendation for prenatal, neonatal and postnatal management of congenital cytomegalovirus infection from the European congenital infection initiative (ECCI)

“…For example, a recent French cost-effectiveness study showed that universal screening in conjunction with valaciclovir treatment would be cost-effective compare to current practice. 32 …”

“… 14 Discordant CMV IgG results are reported for 1.0–2.6% of samples, mainly those with IgG levels below twice the cut-off value of the test. 32 We recommend repeating weakly positive IgG results with a second assay or sending the sera to a reference laboratory. Sera that are positive with both assays can be declared positive; those with discordant results should be considered equivocal and declared negative.…”

Ophthalmic Complications, Diagnosis, and Treatment of Congenital Human Cytomegalovirus Infection

“…There is no consensus in the global literature regarding the cost-effectiveness of hCMV screening in pregnant women [ 138 , 141 , 142 , 143 ]. However, as demonstrated by Périllaud-Dubois et al, universal hCMV screening combined with valacyclovir-based treatment, particularly when hCMV infection is detected in the first trimester of pregnancy, could be more cost-effective than currently accepted strategies for preventing cCMV and treating its complications [ 144 ]. An argument against the introduction of universal hCMV screening is the potential risk of increasing the rate of pregnancy termination in patients diagnosed with primary hCMV infection who may not have developed cCMV or its complications [ 145 ].…”