Estimated Cost-effectiveness of Newborn Screening for Congenital Cytomegalovirus Infection in China Using a Markov Model

Abstract

IMPORTANCE Congenital cytomegalovirus infection (cCMVi) is one of the most common infections associated with childhood hearing loss. Prevention and mitigation of cCMVi-related hearing loss will require an increase in newborn screening, which is not yet available in China. OBJECTIVETo estimate the cost-effectiveness of newborn screening strategies for cCMVi from the perspective of the Chinese health care system. DESIGN, SETTING, AND PARTICIPANTSA decision tree for a simulated cohort population of 15 000 000 live births was developed to compare the costs and health effects of 3 mutually exclusive interventions: (1) no screening, (2) targeted screening using CMV polymerase chain reaction assay for newborns who fail a universal hearing screening, and (3) universal screening for CMV among all newborns. Markov diagrams were used to evaluate the lifetime horizon (76 years). MAIN OUTCOMES AND MEASURESCost, hearing-related health outcomes, and incremental costeffectiveness ratios (ICERs) were estimated based on a direct medical costs perspective. Costs and ICERs were reported in 2018 US dollars. RESULTSIncidence of cCMVi among newborns was reported to be approximately 0.7% in China.Targeted screening was less costly but also less effective than universal screening, identifying 41% of cases needing antiviral treatment and preventing nearly half of less severe or profound hearing loss.To avoid 1 CMV-related severe or profound hearing loss, 13 and 16 newborns need to be treated by targeted and universal screening, respectively. The ICERs of targeted and universal screening vs no screening were $79 and $2087 per quality-adjusted life-year gained, respectively, at the discounted rate of 3.5%. Both screening options were cost-effective for the Chinese health care system based on the willingness-to-pay threshold of 3 × gross domestic product per capita. The sensitivity analysis showed that the prevalence of cCMVi, as well as diagnosis and treatment costs, were key factors that may be associated with decision-making. CONCLUSIONS AND RELEVANCETo achieve cost-effectiveness and best health outcomes, universal screening could be considered for the Chinese population. While the results are specific to China, the model may easily be adapted for other countries.

Predictive significance of neutrophil‐to‐lymphocyte and platelet‐to‐lymphocyte for cytomegalovirus infection in infants less than 3 months: A retrospective study

“…At present, the screening strategies for CMV all over the world include universal screening, targeted screening, and no screening. The universal screening for cytomegalovirus (CMV) postnatally is encouraging 4,35 . However, in China, CMV is not screened now.…”

“…The universal screening for cytomegalovirus (CMV) postnatally is encouraging. 4 , 35 However, in China, CMV is not screened now. Furthermore, CMV‐DNA cannot be detected in parts of hospitals, whereas routine blood test is common, convenient, and inexpensive.…”

Delays in diagnosis and treatment initiation for congenital cytomegalovirus infection - Why we need universal screening

“…The benefits of newborn screening for congenital CMV are multiple: timely diagnosis and initiation of therapy in the majority of children who may otherwise be missed; parental confidence in the diagnosis not being of genetic cause, thereby impacting future decisions for family-planning; and overall reduction in parental stress and anxiety caused by uncertain diagnoses ( 46 ). Universal screening is also likely to be cost-effective if total healthcare and societal costs, including loss of productivity, of the burden of cCMV are taken into account ( 4 , 18 , 20 , 47 , 48 ). Potential negative impacts from screening include possible temporary increased parental stress or altered parent-child relationships from a false positive result; the added costs from unnecessary medical visits or investigations, although this is arguably less than the medical and societal costs of caring for those affected by cCMV ( 49 ).…”

Perinatal Cytomegalovirus Infection

“…In short, universal newborn CMV screening is required for ensuring efficient evaluation of infected newborns, consideration of treatment, and appropriate follow-up care. Given the enormous public health burden and disability costs [65], newborn CMV screening appears to be cost-effective as well as medically beneficial [66][67][68]. Challenges to the implementation of universal newborn CMV screening programs include the poor sensitivity of DBS CMV PCR [69] and the fact that urine or saliva samples are currently not routinely collected at birth.…”