Screening and treating for primary cytomegalovirus infection in pregnancy: where do we stand? A decision-analytic and economic analysis.
OBJECTIVE
To estimate which 1 of 3 screening strategies for primary maternal cytomegalovirus infection, with intention to treat with hyperimmune globulin, is most cost-effective.


METHODS
A decision-analytic and cost-effectiveness model was constructed for pregnant women, comparing 3 strategies screening for primary maternal cytomegalovirus infection with intention to treat with cytomegalovirus-intravenous immune globulin: (1) serum screen all pregnant women, (2) serum screen women with risk factors for primary cytomegalovirus, (3) serum screen women with suspicious sonographic findings. Probability, use (or value), and cost estimates were derived from published literature.


RESULTS
Universal screening for primary maternal cytomegalovirus was the preferred and most cost-effective strategy. However, if treatment with cytomegalovirus-intravenous immune globulin achieved less than a 47% reduction (relative risk, 0.53) in clinical disease, universal screening would no longer be cost-effective.


CONCLUSIONS
Universal screening for primary maternal cytomegalovirus infection is cost-effective based on available evidence, highlighting the urgent need for additional study evaluating the efficacy of cytomegalovirus-intravenous immune globulin to prevent congenital cytomegalovirus.
Cahill
Alison G
AG
Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA.
Odibo
Anthony O
AO
Stamilio
David M
DM
Macones
George A
GA
D003362:Cost-Benefit Analysis; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D018803:Models, Economic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy