In the Journals

Congenital CMV screenings cost-effective, warrant implementation

Universal and targeted newborn screening programs for congenital cytomegalovirus infection were cost-effective in the U.S., according to a study recently published in JAMA Pediatrics.

“At present, diagnosis of (congenital cytomegalovirus [CMV]) infection depends largely on clinical suspicion,” Soren Gantt, MD, PhD, MPH, an investigator at BC Children’s Hospital, University of British Columbia, and colleagues wrote. “However, only a small proportion of symptomatic [congenital] CMV infections are diagnosed using this approach. All infants with [congenital] CMV infection, symptomatic or asymptomatic, may benefit from early diagnosis for anticipatory guidance, early identification of late-onset hearing impairment and appropriate support. Treatment of newborns with symptomatic [congenital] CMV infection with the antiviral drug valganciclovir hydrochloride for 6 months also results in improved hearing and developmental outcomes.”

Soren Gantt

To estimate the cost-effectiveness of universal and targeted congenital CMV screening programs for newborns, Gantt and colleagues produced two models using results and rates from past prospective cohort studies of newborn congenital CMV screening in U.S. postpartum care and early hearing programs. CMV presence in saliva, blood or urine samples defined infection.

The investigators compared the costs of identifying one congenital CMV infection, one case of congenital CMV-related hearing loss and preventing one cochlear implant. They also evaluated the reduction in cases of severe-to-profound hearing loss and the differences in cost per infant for targeted screening and universal screening based on antiviral treatment efficacy.

Identifying one case of congenital CMV by universal screening cost an estimated $2,000 to $10,000 compared with $566 to $2,832 for targeting screening. To identify one case of hearing loss, the cost was as low as $27,460 by universal screening and $975 for targeted screening.

Both screening strategies reduced severe or total hearing loss by an estimated 4.2% to 13%, with a direct cost of $10.86 per screened newborn. In addition, screenings both strategies saved up to $37.97 per newborn.

“We found that screening newborns for [congenital] CMV infection is generally associated with cost savings, or is essentially cost-neutral from the perspective of net public spending, across a wide range of assumptions,” the researchers wrote. “These results, combined with the reported clinical benefits and high parental acceptance, appear to satisfy accepted criteria for newborn screening. Thus, in the absence of a vaccine or other effective methods to prevent [congenital] CMV infection, newborn [congenital] CMV screening appears warranted in the United States.”

In an accompanying commentary, Gail J. Demmler-Harrison, MD, of Texas Children’s Hospital, in Houston, wrote that these findings address the lack of cost-benefit analyses for newborn congenital CMV screening, with a “comprehensive analysis” comparing costs of targeted and universal screening.

“Through their models they show targeted and universal screening of newborns for cCMV are both cost-effective, with universal screening offering the larger net savings and the better opportunity for comprehensive, directed care,” she wrote. “Whether we begin with targeted newborn testing or jump right into universal newborn screening, it is time for newborn screening for [congenital] CMV. – by Kate Sherrer

Disclosure: Gantt reports he received funding from an establishment award from the Child & Family Research Institute; Demmler-Harrison reports receiving grant support from the CDC and Merck & Co., and receives research grant support from the National Institute of Allergy and Infectious Diseases/National Institutes and Health Collaborative Antiviral Study Group. Please see a list of the full study for all other authors’ financial disclosures.

Universal and targeted newborn screening programs for congenital cytomegalovirus infection were cost-effective in the U.S., according to a study recently published in JAMA Pediatrics.

“At present, diagnosis of (congenital cytomegalovirus [CMV]) infection depends largely on clinical suspicion,” Soren Gantt, MD, PhD, MPH, an investigator at BC Children’s Hospital, University of British Columbia, and colleagues wrote. “However, only a small proportion of symptomatic [congenital] CMV infections are diagnosed using this approach. All infants with [congenital] CMV infection, symptomatic or asymptomatic, may benefit from early diagnosis for anticipatory guidance, early identification of late-onset hearing impairment and appropriate support. Treatment of newborns with symptomatic [congenital] CMV infection with the antiviral drug valganciclovir hydrochloride for 6 months also results in improved hearing and developmental outcomes.”

Soren Gantt

To estimate the cost-effectiveness of universal and targeted congenital CMV screening programs for newborns, Gantt and colleagues produced two models using results and rates from past prospective cohort studies of newborn congenital CMV screening in U.S. postpartum care and early hearing programs. CMV presence in saliva, blood or urine samples defined infection.

The investigators compared the costs of identifying one congenital CMV infection, one case of congenital CMV-related hearing loss and preventing one cochlear implant. They also evaluated the reduction in cases of severe-to-profound hearing loss and the differences in cost per infant for targeted screening and universal screening based on antiviral treatment efficacy.

Identifying one case of congenital CMV by universal screening cost an estimated $2,000 to $10,000 compared with $566 to $2,832 for targeting screening. To identify one case of hearing loss, the cost was as low as $27,460 by universal screening and $975 for targeted screening.

Both screening strategies reduced severe or total hearing loss by an estimated 4.2% to 13%, with a direct cost of $10.86 per screened newborn. In addition, screenings both strategies saved up to $37.97 per newborn.

“We found that screening newborns for [congenital] CMV infection is generally associated with cost savings, or is essentially cost-neutral from the perspective of net public spending, across a wide range of assumptions,” the researchers wrote. “These results, combined with the reported clinical benefits and high parental acceptance, appear to satisfy accepted criteria for newborn screening. Thus, in the absence of a vaccine or other effective methods to prevent [congenital] CMV infection, newborn [congenital] CMV screening appears warranted in the United States.”

In an accompanying commentary, Gail J. Demmler-Harrison, MD, of Texas Children’s Hospital, in Houston, wrote that these findings address the lack of cost-benefit analyses for newborn congenital CMV screening, with a “comprehensive analysis” comparing costs of targeted and universal screening.

“Through their models they show targeted and universal screening of newborns for cCMV are both cost-effective, with universal screening offering the larger net savings and the better opportunity for comprehensive, directed care,” she wrote. “Whether we begin with targeted newborn testing or jump right into universal newborn screening, it is time for newborn screening for [congenital] CMV. – by Kate Sherrer

Disclosure: Gantt reports he received funding from an establishment award from the Child & Family Research Institute; Demmler-Harrison reports receiving grant support from the CDC and Merck & Co., and receives research grant support from the National Institute of Allergy and Infectious Diseases/National Institutes and Health Collaborative Antiviral Study Group. Please see a list of the full study for all other authors’ financial disclosures.