The cost-effectiveness of neonatal versus prenatal screening for congenital toxoplasmosis

Abstract

BackgroundCongenital Toxoplasmosis (CT) can have severe consequences. France, Austria, and Slovenia have prenatal screening programs whereas some other countries are considering universal screening to reduce congenital transmission and severity of infection in children. The efficiency of such programs is debated increasingly as seroprevalence among pregnant women and incidence of congenital toxoplasmosis show a steady decrease. In addition, uncertainty remains regarding the effectiveness of pre- and postnatal treatments.MethodTo identify cost-effective strategies, prenatal and neonatal screenings were compared using a decision-analytic model based on French guidelines and current knowledge of long-term evolution of the disease in treated children. Epidemiological data were extracted from the scientific literature and clinical data from the French Lyon cohort. Strategies were compared at one year of age, when infection can be definitively evaluated, and at 15 years of age, after which validated outcome data become scarce. The analysis was performed from the French Health Insurance System perspective and included direct medical costs for pregnant women and their children.ResultsThe 1-year Incremental Cost-Effectiveness Ratio showed that prenatal screening would require investing €14,826 to avoid one adverse event (liveborn with CT, fetal loss, neonatal death or pregnancy termination) compared to neonatal screening. Extra investment increased up to €21,472 when considering the 15-year endpoint.ConclusionsPrenatal screening is cost-effective as compared to neonatal screening in moderate prevalence areas with predominant Type II strains. In addition, prenatal screening, by providing closer follow-up of women at risk increases the number of occasions for education avoiding toxoplasmosis.

Congenital toxoplasmosis in humans: an update of worldwide rate of congenital infections

“…The morbidity of congenital toxoplasmosis in children is very high and true suffering may be underestimated (Havelaar et al, 2007;Bénard et al, 2008;Stillwaggon et al, 2011;Torgerson and Mastroiacovo, 2013;El Bissati et al, 2018;Binquet et al, 2019;Picone et al, 2020). One study estimated 1.2 million disability-adjusted life years and an estimated 190 100 cases globally (Torgerson and Mastroiacovo, 2013).…”

National perinatal survey demonstrates a decreasing seroprevalence of Toxoplasma gondii infection among pregnant women in France, 1995 to 2016: impact for screening policy

“…It was estimated that in 2008, based on a seroprevalence of 38%, the cost was EUR 43 million per year and that the decreasing seroprevalence was increasing the cost by EUR 1 million per year due to additional monthly testing [ 48 ]. One French study, using a seroprevalence of 36.7%, estimated an additional cost of EUR 232,631 per direct toxoplasmosis-related event avoided when comparing current prenatal screening to a potential neonatal screening scenario [ 49 ]. When a wider range of adverse events was included the cost per outcome avoided reduced to EUR 14,826.…”

The Methodological Quality and Challenges in Conducting Economic Evaluations of Newborn Screening: A Scoping Review

“…After duplicate removals, 716 articles were considered eligible for screening by title and abstract. After full-text screening, 35 articles were included for the final assessment (see Appendix C for the PRISMA flow diagram) [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ]. No additional studies were found on the websites of the INAHTA HTA agencies.…”