Targeted screening for congenital cytomegalovirus: A micro‐costing analysis

Abstract

Aim: We aimed to determine the cost and potential cost-savings of delivering a targeted congenital cytomegalovirus (cCMV) screening programme through a universal newborn hearing screening (UNHS) programme to detect cCMV-related hearing loss in infants from Victoria, Australia. Methods: We completed a micro-costing analysis from a health-care perspective using data from a targeted cCMV screening programme piloted between June 2019 and March 2020. The programme involved collection of saliva samples to test for cCMV in infants who: received a 'refer' result on their second newborn hearing screen; were aged 21 days or less; and born at one of four maternity hospitals in Victoria, Australia. All costs to complete targeted cCMV screening were recorded in Australian 2020 dollars. Potential costs and benefits of adding targeted cCMV screening to the pre-existing UNHS programme were compared to when no screening was available up to 18 years to determine the likely cost or cost savings.

Newborn cytomegalovirus screening: is this the new standard?

“…As mentioned above, the vast majority of cCMV goes undiagnosed in the absence of a systematic newborn screening program [17,33]. The major justifications for cCMV screening, therefore, include the direct medical benefits and cost-effectiveness derived from the ability to provide early, beneficial interventions for affected children [33,[40][41][42][43][44][45][46][47]. However, there may also be significant value to families that comes from simply having a diagnosis and avoiding other unnecessary testing [33].…”

“…It is well known that only a small fraction of symptomatic cases is diagnosed clinically; thus, most infants who could benefit from this treatment do not receive it without cCMV screening [17,33,40]. In contrast, there is concern that screening could lead to overtreatment with antivirals, e.g., for asymptomatic infection Cost and burden to healthcare systems cCMV screening is estimated to be highly cost-effective according to numerous studies [40][41][42][43][44][45][46][47]. This is true for both targeted and universal antiviral approaches, though universal screening appears to be superior due to the large number of children whose postnatal-onset hearing loss is identified earlier [40].…”

“…cCMV screening is estimated to be highly cost-effective according to numerous studies [40–47]. This is true for both targeted and universal antiviral approaches, though universal screening appears to be superior due to the large number of children whose postnatal-onset hearing loss is identified earlier [40].…”

Letter to the Editor

“…The authors suggested that targeted congenital cytomegalovirus (cCMV) screening through saliva polymerase chain reaction (PCR) in infants who fail the universal newborn hearing screening (UNHS) falls within the range between cost neutral and cost saving. 1 We believe that the results of the micro-costing analysis performed by Dr. Gillespie and colleagues might have important implications for clinical practice because this targeted cCMV screening method is not only feasible and acceptable to parents, 2 but also provides the opportunity to start the treatment with oral Valganciclovir within the first month of life, which has been shown to have a favourable effect on long-term hearing and neurodevelopmental outcomes. 3 Therefore, we concur with the authors that early antiviral therapy could prevent or improve hearing loss in children with cCMV, although the choice of this treatment should be a shared decision between parents and paediatricians after discussing the potential benefits and risks.…”

“…1,2 Umberto Ambrosetti1 1 Department of Clinical Sciences and Community Health, University of Milan 2 Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy mirko.alde@unimi.it; umberto.ambrosetti@unimi.it Accepted for publication 6 April 2023.…”