Abstract Details
9/08/2025 | 2:00 PM - 3:00 PM | Breakout 2 | Ski-U-Mah
Understanding cost-effectiveness analysis and how it can inform CMV clinical care guidelines
Abstract Summary
Simulation modeling and cost-effectiveness analyses are powerful tools that can translate data from cohort studies and trials into recommendations for clinical care (e.g., guidelines from professional societies). Models incorporate high-quality data from multiple sources, then project outcomes beyond the time horizon of clinical studies. Cost-effectiveness analysis is a formal method to identify how limited healthcare resources can best be used to improve clinical outcomes. Models are particularly useful when outcomes are difficult to study through trials or cohorts – e.g., when long follow-up times or large sample sizes would be needed, when outcomes occur primarily among people who are not engaged in research studies, or when comparison is needed of multiple of interventions that cannot be evaluated in a single study. Model-based methods also rigorously assess the impact of uncertainty, asking, for example: how would policy recommendations change if key factors – such as prevalence, test sensitivity/specificity, or healthcare costs – were different? Guidelines for cCMV screening in the US could be informed by model-based analyses, given the unique context of its health care system. In this session, we will: 1) Review core elements of simulation modeling and cost-effectiveness analysis, including how to set up a research question suited for these methods and how to critically read a published modeling or cost-effectiveness paper. 2) Discuss examples of how these methods have informed clinical guidelines in infectious diseases, including guidelines for HIV prevention and treatment in pregnancy and childhood. 3) Summarize cost-effectiveness analyses to date in the field of cCMV, which have examined screening among pregnant people and newborns in Europe, Canada, and the US, as well as vaccines in multiple countries. 4) Identify gaps in the existing literature and highlight opportunities for these methods to inform anticipated revisions to US-based guidelines for CMV screening and treatment in pregnant people and infants.
Learning Objectives
- Identify core elements of model-based cost-effectiveness analysis and how to critically read and assess published modeling or cost-effectiveness papers
- Review existing cost-effectiveness models for CMV screening and treatment in pregnancy and infancy
- Describe the contribution of model-based analyses to cCMV policy to date, their limitations for policy-making in the US, and opportunities for additional impact
Presentation
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Presenters
Andrea Ciaranello | Primary Presenter
aciaranello@partners.org;
Dr. Ciaranello is a Professor of Medicine at Harvard Medical School and an infectious disease physician at Massachusetts General Hospital. She serves as director of the Perinatal Infectious Disease Program at MGH and Director of the Program in Health Economics and Modeling at the Harvard University Center for AIDS Research. She is also Co-Chair of the US Department of Health and Human Services Panel on Treatment of HIV in Pregnancy and Prevention of Perinatal Transmission and has served as technical consultant for UNAIDS and WHO about simulation modeling and cost-effectiveness related to pediatric HIV and vertical HIV transmission. Her research interests involve the use of simulation models to examine the long-term clinical outcomes and cost-effectiveness of strategies to care for women and children affected by infectious diseases.
ASHA DISCLOSURE
Financial - No relevant financial relationship exists.
Nonfinancial - No relevant nonfinancial relationship exists.
AAA DISCLOSURE
Financial - No relevant financial relationship exists.
Elif Coskun | Co-Author
ecoskun1@mgh.harvard.edu;
Elif Coskun is a Research Specialist at the Medical Practice Evaluation Center at Massachusetts General Hospital, focusing on pediatric infectious disease modeling. She received her Masters in Public Health focusing on biostatistics and epidemiology from Boston University and currently works on several modeling and cost-effectiveness analyses focusing on vertical transmission of infectious diseases.
ASHA DISCLOSURE
Financial - No relevant financial relationship exists.
Nonfinancial - No relevant nonfinancial relationship exists.
AAA DISCLOSURE
Financial - No relevant financial relationship exists.
Malavika Prabhu | Co-Author
mprabhu@mgb.org;
Dr. Prabhu is an Assistant Professor of Obstetrics, Gynecology, and Reproductive Biology at HMS and a board-certified maternal-fetal medicine (MFM) specialist at MGH. Her research focuses on understanding how to decrease infectious disease-associated complications in pregnancy. She has conducted quality improvement research on optimizing the practice and delivery of obstetric care for chorioamnionitis, sepsis, CMV, and COVID-19, among others. She serves as the Vice Chair of the Publication Committee of the Society for Maternal-Fetal Medicine (SMFM), a position in which she oversees the development and publication of all clinical care guidelines from this leading US obstetrics society.
ASHA DISCLOSURE
Financial -
Nonfinancial -
AAA DISCLOSURE
Financial - No relevant financial relationship exists.
Clare Flanagan | Co-Author
cflanagan2@partners.org;
Ms. Flanagan is a Project Manager/Scientist at the Medical Practice Evaluation Center. She has extensive expertise in the use of simulation models to inform maternal-child health policy. She also has more than a decade of experience in project management for clinical research, and a particular interest in the dissemination of scientific findings for a range of audiences.
ASHA DISCLOSURE
Financial -
Nonfinancial -
AAA DISCLOSURE
Financial - No relevant financial relationship exists.
Megan Pesch | Co-Author
pesch@med.umich.edu;
Dr. Megan Pesch is a Developmental and Behavioral Pediatrician at the University of Michigan where she is the Director of the Congenital CMV Follow-up Clinic. Her research focuses on developmental outcomes of children with cCMV and the experiences of their families. She is the proud mother of three little girls, the youngest of whom is Deaf and has cCMV.
ASHA DISCLOSURE
Financial -
Nonfinancial -
AAA DISCLOSURE
Financial - No relevant financial relationship exists.
Megan Nix | Co-Author
nix.megan@gmail.com;
Ms. Nix is the author of the book Remedies for Sorrow, an investigative memoir published by Doubleday about her second daughter who was born with congenital CMV. Megan was a National CMV Foundation Community Alliance Chair, and her work has appeared in The New York Times, The Boston Globe, The Washington Post, Romper, and elsewhere. Megan is a mother to five young children, and she divides her time between Colorado and a remote island in Alaska where her husband fishes for a living.
ASHA DISCLOSURE
Financial -
Nonfinancial -
AAA DISCLOSURE
Financial - No relevant financial relationship exists.
Aaron Wu | Co-Author
aawu@mgh.harvard.edu;
Mr. Wu is a C/C++ and Python Software Programmer at the Medical Practice Evaluation Center. He has been leading the efforts to design, implement, and validate LINCS model of CMV in pregnancy. He has experience developing and maintaining microsimulation models of infectious diseases, and contributing to public health research using findings from modeling studies.
ASHA DISCLOSURE
Financial -
Nonfinancial -
AAA DISCLOSURE
Financial - No relevant financial relationship exists.
Anne Neilan | Co-Author
aneilan@mgh.harvard.edu;
Dr. Neilan is an Associate Professor at Harvard Medical school and a Faculty Member at the Medical Practice Evaluation Center. She is an Infectious Diseases Physician, board-certified in pediatrics, medicine, and adult infectious diseases. Her clinical and research focus is on care for adolescents and young adults affected by infectious diseases. She has led simulation modeling and cost-effectiveness analyses in both the US and internationally on HIV testing, treatment, prevention, and interventions to improve adherence to medications in adolescents and young adults.
ASHA DISCLOSURE
Financial -
Nonfinancial -
AAA DISCLOSURE
Financial - No relevant financial relationship exists.
Caitlin Dugdale | Co-Author
cdugdale@mgh.harvard.edu;
Dr. Dugdale is an Infectious Disease Physician at MGH, an Assistant Professor of Medicine at HMS, and a Faculty Member at the Medical Practice Evaluation Center (MPEC). She has substantial expertise in modeling strategies to prevent vertical transmission of infectious diseases and improve maternal health, and she has published modeling analyses on a broad range of topics, including co-located maternal-child service delivery, the use of dolutegravir for people of childbearing potential, and the use of broadly neutralizing antibodies (bNAbs) for infant postnatal HIV prophylaxis.
ASHA DISCLOSURE
Financial -
Nonfinancial -
AAA DISCLOSURE
Financial - No relevant financial relationship exists.
John Giardina | Co-Author
jgiardina2@mgh.harvard.edu;
Dr. Giardina is a Faculty Decision Scientist/Biostatistician and Associate Investigator at the Medical Practice Evaluation Center. He is an expert in simulation modeling, cost-effectiveness analysis, and machine learning-based approaches to optimizing interpretation of both simulation model output and primary patient-level data. He previously worked on a highly-cited simulation model of COVID-19 in K-12 schools, and he has worked extensively in the development and validation of the LINCS CMV microsimulation model.
ASHA DISCLOSURE
Financial -
Nonfinancial -
AAA DISCLOSURE
Financial - No relevant financial relationship exists.
Fatima Kakkar | Co-Author
fatima.kakkar@umontreal.ca;
Dr Fatima Kakkar is a pediatric infectious diseases specialist and clinician-researcher in congenital infections at Sainte-Justine University Health Center in Montreal, Canada, and Associate Professor of Pediatrics at the University of Montreal. She co-directs the Women and Children’s Infectious Diseases Center “Centre d’infectiologie mère-enfant”, which provides care for infants affected by congenital infections in pregnancy.
ASHA DISCLOSURE
Financial -
Nonfinancial -
AAA DISCLOSURE
Financial - No relevant financial relationship exists.