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Healthcare Policy/Economics

Poster Session 3

(876) Universal Screening and Valacyclovir for Maternal Primary CMV in the First Trimester: A Cost-Effectiveness Analysis

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Universal prenatal screening for CMV is not recommended in the United States as, historically, no effective interventions were available. With growing evidence that valacyclovir treatment in first trimester primary infections reduces vertical transmission, universal screening may become an important tool in congenital CMV prevention. This study examined the cost-effectiveness of universal screening for first trimester primary CMV and subsequent valacyclovir treatment for congenital CMV prevention in the United States.

Study Design: A decision-analytic model was constructed to compare outcomes of universal screening and valacyclovir treatment in a theoretical cohort of 3,664,292 individuals, the estimated number of annual live births in the United States. Individuals found to be IgG+, IgM+, and to have low IgG avidity were considered to have primary CMV infection and received valacyclovir. Outcomes included correctly diagnosed primary CMV infections, cases of vertical CMV transmission, abortions, stillbirths, neonatal deaths, hearing loss, neurodevelopmental disabilities, costs, and quality adjusted life years (QALYs). Model inputs were derived from literature.

Results: In our study, universal screening in the first trimester for primary CMV and subsequent treatment with valacyclovir in positive cases correctly diagnosed 28,475 cases of primary CMV, led to 385 additional abortions, and decreased adverse outcomes by 9,559 vertical transmission cases, 43 stillbirths, 40 neonatal deaths, 1,238 cases of hearing loss, and 276 cases of neurodevelopmental disability. Universal screening and subsequent treatment was the dominant strategy as it saved $608,668,546 and led to 6,222 additional QALYs.

Conclusion: Our results demonstrate that screening for first trimester primary CMV may be a cost-saving intervention, as identification of cases allows for the provision of treatment, which in turn reduces CMV transmission and costly sequelae.