Cost-benefit analysis of screening for toxoplasmosis during pregnancy.
Congenital toxoplasmosis is a risk for fetus both in 'low' and 'high risk' areas. A cost-benefit analysis based on data from a Finnish prospective study (20.3% seropositivity of pregnant mothers and incidence of 2.4/1,000 seronegative pregnancies) and on Finnish cost data was performed to compare the no-screening and screening alternatives for primary toxoplasma infections during pregnancy. A maternal-feto transmission risk of 40%, effectiveness of treatment of 50%, and discount rate of 4% were used as other baseline probabilities. The calculations were carried out by decision analysis combined with sensitivity analysis. The total annual costs of congenital toxoplasmosis without screening amount to US$ 128/pregnancy/year, and with systematic serological screening, US$ 95/pregnancy. Thus screening reduces the costs by 25%. The present value of net savings in Finland would be US$ 2.1 million every year. A one-way sensitivity analysis showed that screening together with health education is preferable to health education without screening if the incidence of maternal primary infections exceeds 1.1/1,000 and effectiveness of treatment is better than 22.1%. Screening for toxoplasma infections during pregnancy is economically worthwhile even in a country with a low incidence. A scheme of systematic screening for maternal primary toxoplasma infections combined with health education should be considered.
Lappalainen
M
M
Haartman Institute, Department of Virology, University of Helsinki, Finland.
Sintonen
H
H
Koskiniemi
M
M
Hedman
K
K
Hiilesmaa
V
V
Ammälä
P
P
Teramo
K
K
Koskela
P
P
D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D005387:Finland / Q000453:epidemiology; D006266:Health Education; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000191:economics; D008403:Mass Screening / Q000191:economics*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D014123:Toxoplasmosis / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D014125:Toxoplasmosis, Congenital / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control