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Cost-Effectiveness of Screening Strategies for Congenital Cytomegalovirus Infection: The U.S. Healthcare Perspective

Abstract Summary

Kate L. Wilson, DO, MS1, Michael T. Halpern, MD, PhD, MPH2 and Gary M. Weiner, MD1 1Department of Pediatrics, Division of Neonatology, University of Michigan, Ann Arbor, MI 2Healthcare Delivery Research Program, National Cancer Institute, Rockville, MD Objective: Screening strategies to identify newborns with congenital cytomegalovirus (cCMV) are needed to allow at risk infants opportunities for therapies to mitigate hearing loss. Our objectives were to determine the cost-effectiveness of newborn cCMV screening from the U.S. healthcare system perspective using saliva PCR testing, and to use sensitivity analyses to identify key areas of uncertainty. Design: Cost-effectiveness was estimated using a decision-analysis model to compare no routine screening with targeted and universal screening using parameters obtained from published literature. A theoretical cohort of 1000 newborns was modeled. Costs were reported in 2022 U.S. dollars using a 3% discounting rate over a 12-year childhood and over the U.S. life expectancy. Effectiveness was assessed by quality adjusted life years (QALYs). Primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as cost per QALY gained using a $100,000/QALY willingness-to-pay (WTP) threshold. Deterministic sensitivity analyses (SA) and probabilistic Monte Carlo (MC) simulations were performed. Secondary outcome was incremental cost to prevent one case of moderate-to-severe CMV-related hearing loss. Results: Compared to either no screening or universal screening, targeted screening was the preferred strategy ($11,578/QALY gained) and remained the preferred strategy ($41,541/QALY gained) over the shortened time horizon. The ICER for universal screening versus targeted screening exceeded the commonly accepted threshold ($160,828/QALY gained). Using one-way SA, the decision supporting targeted screening was robust to wide variation in model inputs including the efficacy of valganciclovir. Targeted screening was the optimal decision in most MC simulations. Cost to prevent one case of moderate-to-severe CMV-related hearing loss ranged from $218,780 (targeted screening) to $1,791,021 (universal screening). Conclusion: Targeted saliva PCR screening triggered by a failed hearing screen is a cost-effective strategy to identify newborns with cCMV from the U.S. healthcare perspective. SA confirmed that the decision is robust to uncertainty. These findings support public policy initiatives to add targeted cCMV screening to newborn screening.

Learning Objectives

• Estimate the cost-effectiveness of three screening strategies for congenital CMV
• Describe decision-analysis model, inputs, and analyses.
• Discuss importance, limitations, and applicability of optimal screening strategy by model for newborn CMV screening.

Presentation

3440589_16097KateWilson.pdf

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