Universal first-trimester cytomegalovirus screening and valaciclovir prophylaxis in pregnant persons: a cost-effectiveness analysis

Fisher, Stephanie A.; Yee, Lynn M.; Grobman, William A.; Premkumar, Ashish

doi:10.1016/j.ajogmf.2022.100676

Cited by 11 publications

(5 citation statements)

References 106 publications

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“…Since then, a meta-analysis of the results of three recent studies has concluded that valaciclovir is effective for secondary prevention of maternal-fetal transmission of CMV [115,[139][140][141]]. An American cost-effectiveness analysis, based on a cost of USD 100,000 per quality-adjusted life year (QALY), demonstrated that universal first-trimester serological screening for primary maternal CMV infection is not cost-effective as it resulted in only 14 fewer children being affected with cytomegalovirus per 100,000 pregnancies when compared to usual care [142]. A French study assessed the cost-effectiveness of prenatal detection of congenital cytomegalovirus following maternal primary infection during the first trimester within standard pregnancy follow-up or involving population-based screening (serological testing at 7 and 12 weeks of gestation).…”

Section: Diagnosis Of Maternal Infection and Screening Strategiesmentioning

confidence: 99%

Primary, Secondary, and Tertiary Prevention of Congenital Cytomegalovirus Infection

Sartori

Egloff

Hcini

et al. 2023

Viruses

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Cytomegalovirus infection is the most common congenital infection, affecting about 1% of births worldwide. Several primary, secondary, and tertiary prevention strategies are already available during the prenatal period to help mitigate the immediate and long-term consequences of this infection. In this review, we aim to present and assess the efficacy of these strategies, including educating pregnant women and women of childbearing age on their knowledge of hygiene measures, development of vaccines, screening for cytomegalovirus infection during pregnancy (systematic versus targeted), prenatal diagnosis and prognostic assessments, and preventive and curative treatments in utero.

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Section: Diagnosis Of Maternal Infection and Screening Strategiesmentioning

confidence: 99%

Primary, Secondary, and Tertiary Prevention of Congenital Cytomegalovirus Infection

Sartori

Egloff

Hcini

et al. 2023

Viruses

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“…An argument for universal hCMV screening is the operation of similar programs targeting congenital diseases, albeit less common than cCMV, which cause varying degrees of disability in children, such as toxoplasmosis, rubella, syphilis, early group B streptococcal infection, Down syndrome, and spina bifida [ 40 , 139 , 140 ]. 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 ].…”

Section: Discussionmentioning

confidence: 99%

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

Modrzejewska,

Połubiński,

Zdanowska

2024

JCM

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Background: Human cytomegalovirus (hCMV) is the most common etiological agent of congenital infections seen in newborns. Among the most commonly observed complications in children with congenital human cytomegalovirus infection are those affecting the visual system. Ocular complications of congenital CMV (cCMV) are a topic rarely addressed in the literature, which prompted the authors to update the available knowledge with the latest data. Methodology: English-language literature published between April 2000 and November 2023 (PubMed, NIH, Google Scholar) was analyzed for ocular complications of cCMV. The data obtained were categorized according to the ocular area involved and the incidence. A compilation of criteria for the symptomatic form of cCMV was also created. Results: The cCMV complications described in the literature affect all parts of the visual system: the anterior segment, the posterior segment, the posterior visual pathways, and the visual cortex. The most commonly described ocular complication of cCMV is choroidal and retinal scarring. Conclusions: Ophthalmic complications of cCMV can cause severe visual disturbances. Ophthalmic diagnosis in newborns should include hCMV PCR testing, which has the highest sensitivity and specificity. In the symptomatic form of cCMV, treatment should be instituted according to recommendations. A consensus should be established for screening of primary hCMV infection in pregnant women, the way in which to define the symptomatic form of cCMV, and the appropriateness and standards of treatment for primary hCMV infection in pregnant women.

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“…We included all of the postnatal costs of cCMV follow-up, regardless of whether cCMV infection was diagnosed (including wandering diagnostic costs). Fisher et al 39 performed a cost-effectiveness analysis to compare the strategy 'T1 PI screening and valacyclovir' with the control strategy 'no systematic screening' in the USA. They concluded that the test-and-treat strategy was not cost-effective, with a WTP set at $100 000/quality-adjusted life years (QALY).…”

Section: Discussionmentioning

confidence: 99%

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

Périllaud-Dubois

Hachicha-Maalej

Lepers

et al. 2023

Ultrasound in Obstet & Gyne

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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.

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Universal first-trimester cytomegalovirus screening and valaciclovir prophylaxis in pregnant persons: a cost-effectiveness analysis

Cited by 11 publications

References 106 publications

Primary, Secondary, and Tertiary Prevention of Congenital Cytomegalovirus Infection

Primary, Secondary, and Tertiary Prevention of Congenital Cytomegalovirus Infection

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

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

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