Congenital toxoplasmosis in Austria: Prenatal screening for prevention is cost-saving

Abstract

BackgroundPrimary infection of Toxoplasma gondii during pregnancy can be transmitted to the unborn child and may have serious consequences, including retinochoroiditis, hydrocephaly, cerebral calcifications, encephalitis, splenomegaly, hearing loss, blindness, and death. Austria, a country with moderate seroprevalence, instituted mandatory prenatal screening for toxoplasma infection to minimize the effects of congenital transmission. This work compares the societal costs of congenital toxoplasmosis under the Austrian national prenatal screening program with the societal costs that would have occurred in a No-Screening scenario.Methodology/Principal findingsWe retrospectively investigated data from the Austrian Toxoplasmosis Register for birth cohorts from 1992 to 2008, including pediatric long-term follow-up until May 2013. We constructed a decision-analytic model to compare lifetime societal costs of prenatal screening with lifetime societal costs estimated in a No-Screening scenario. We included costs of treatment, lifetime care, accommodation of injuries, loss of life, and lost earnings that would have occurred in a No-Screening scenario and compared them with the actual costs of screening, treatment, lifetime care, accommodation, loss of life, and lost earnings. We replicated that analysis excluding loss of life and lost earnings to estimate the budgetary impact alone.Our model calculated total lifetime costs of €103 per birth under prenatal screening as carried out in Austria, saving €323 per birth compared with No-Screening. Without screening and treatment, lifetime societal costs for all affected children would have been €35 million per year; the implementation costs of the Austrian program are less than €2 million per year. Calculating only the budgetary impact, the national program was still cost-saving by more than €15 million per year and saved €258 million in 17 years.Conclusions/SignificanceCost savings under a national program of prenatal screening for toxoplasma infection and treatment are outstanding. Our results are of relevance for health care providers by supplying economic data based on a unique national dataset including long-term follow-up of affected infants.

Seroprevalence of Toxoplasma gondii, Rubella and Cytomegalovirus Among Pregnant Refugees and Turkish Women: A Retrospective Comparative Study

“…[7][8][9] The results were similar in every study conducted in Turkey. When we checked other countries, the seropositivity rates of T. gondii were 7% in Norway, 10% in the United Kingdom, 19% in Italy, 29.9 in Sri Lanka, [10] 31.7% in Thailand-Myanmar, [11] 32% in Spain, 33% in Austria, 34% in Slovenia, 44% in France, [12] 46.2% in Yemen, [13] and 82.6% in Lebanon. [14] Our results were similar to Mediterranean countries.…”

Treatment of Toxoplasmosis: Historical Perspective, Animal Models, and Current Clinical Practice

“…A mathematical model found the implementation of universal maternal screening in the United States to be cost-effective, but its impact diminished when the incidence of CT also decreased unless the cost of serological testing was also adjusted (189). A recent European paper also demonstrates the cost-effectiveness of universal maternal screening (190).…”

Serological and molecular rapid diagnostic tests for Toxoplasma infection in humans and animals

“…Early detection of congenital Toxoplasma infection may reduce transplacental transmission and lessen the fetal disease burden [5,6]. Usually, T. gondii infection in pregnant women is asymptomatic, and countries like Austria [7], France [8], and Brazil [9] conduct routine maternal screening to identify the infected pregnant woman and provide early treatment.…”