[How can the cost of screening for toxoplasmosis during pregnancy be reduced?].
BACKGROUND
A program of systematic serology screening for toxoplasmosis during pregnancy has been running in France since 1978. The program involves monthly follow-ups for all non-immune pregnant women. Due to the steady decline in the seroprevalence of toxoplasmosis, the cost of the program is steadily increasing. Current screening is based on the detection of IgG and IgM isotypes. The aim of this work was to estimate the benefit of replacing combined dosage of two isotypes, by an alternative strategy that detects total anti-Toxoplasma immunoglobulins.


METHODS
The rate of decreasing seroprevalence and the increasing burden on serological examinations was measured in a study population of pregnant women who were checked for toxoplasmosis by the parasitology laboratory of the Cochin Hospital, Paris. The increase in screening costs was estimated for the all-pregnant women and the expected benefits stemming from simply measuring total anti-Toxoplasma immunoglobulins compared to the double IgG-IgM assay were estimated.


RESULTS
Between 1987 and 2008, the seroprevalence of toxoplasmosis measured at the Cochin hospital dropped from 70.8% to 48.6% with a 1.77% annual rate of decline. This downward trend is similar to that observed by the national perinatal surveys performed in 1995 and in 2003. As the number of non-immune women to follow-up each month is constantly increasing, the proportion of negative tests issued reached 87.6% in 2008. Extrapolating these results to the whole of France, we estimated that the number of required screening tests perform was increasing by 93,000 units per year with an additional associated cost of one million euros. Various alternative scenarios of antibody detection are proposed that could save between 40.2% and 48.4% of current screening costs.


CONCLUSIONS
Replacement of combined dosage of IgG and IgM isotypes by determination of just total Ig would significantly reduce costs of toxoplasmosis screening for pregnant women, without effecting either the general strategy, or proven efficiency of the national program.
Ancelle
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Laboratoire de parasitologie-mycologie, hôpital Cochin, faculté de médecine Paris-Descartes, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France. thierry.ancelle@parisdescartes.fr
Yera
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Talabani
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Lebuisson
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Thulliez
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Dupouy-Camet
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D000913:Antibodies, Protozoan / Q000097:blood; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008403:Mass Screening / Q000191:economics*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000175:diagnosis* / Q000453:epidemiology; D016036:Seroepidemiologic Studies; D014123:Toxoplasmosis / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology
D000913:Antibodies, Protozoan; D007074:Immunoglobulin G; D007075:Immunoglobulin M