Universal Screening for Newborn Congenital CMV Cost-Effective But Concerns Remain

Universal and targeted screening for congenital cytomegalovirus (CMV) appears to be more cost-effective than no screening, which is the current standard of care, according to a study published in JAMA Pediatrics.¹

Soren Gantt, MD, PhD, MPH, from the Department of Pediatrics at the University of British Columbia, Vancouver, and colleagues constructed 2 modeling studies and compared them with the current standard of care for congenital CMV infection: universal screening model, where all newborns were tested; and targeted screening model, where only those who failed the universal newborn hearing screening were tested.

The analysis was performed from July 2014 to March 2016. Estimates of the rates and outcomes of congenital CMV screening were obtained from large prospective cohort studies. Medicaid reimbursement rates were used for all cost estimates.

Among the 551 children with congenital CMV infection, 4% (22) had hearing loss at birth and 12.9% (71) developed hearing loss.  “The results of the universal and targeted screening models ranged from modest direct costs of $10.86 (sensitivity analysis, $6.97 to $14.73) to net savings of $37.97 (sensitivity analysis, $14.60 to $61.34) per newborn undergoing screening,” the researchers wrote.  Both approaches were most cost-effective if antiviral therapy was assumed to be given.

“Universal screening of congenital CMV is currently not the standard of care anywhere at this time in part because of recent developments,” said Dr Gantt in an audio interview with The JAMA Network.² Using saliva swab testing, which is more convenient and more sensitive, rather than urine or dried blood spots is a recent development along with the use of antiviral therapy.  In addition, “inertia to introduce an entirely new testing platform like saliva sample collection on every newborn is a big endeavor and may be costly to develop and set up in some places,” Dr Gantt further explained in the interview.

Because antiviral therapy is a new development, one of the important limitations of this study includes the unclear long-term benefits of such treatment. Other limitations include “estimates of the costs of screening, costs associated with hearing loss, and assumptions about the impact of early intervention,” the researchers wrote. Because hearing loss has lifetime effects, there is uncertainty in the indirect cost of hearing loss resulting in loss of productivity.

This study looked at infants who had symptomatic congenital CMV infection at birth. At present, infants with asymptomatic infection who have no hearing loss at birth are not eligible to receive antiviral treatment and no consensus exists on other testing.  “There are a number of concerns about CMV screening in the community.  Some experts are concerned that a vast majority of infants with congenital CMV infection will not have any permanent problems, so could there be risks of identifying these babies at birth through screening programs including parental anxiety, inappropriate diagnostic testing, or inappropriate use of antiviral therapy for these children,” concluded Dr Gantt in the audio interview. More evidence will be needed to support the treatment of neonates with asymptomatic infection.

References

1. Gantt S, Dionne F, Kozak FK, et al. Cost-effectiveness of universal and targeted newborn screening for congenital cytomegalovirus infection. JAMA Pediatr. 2016 Oct 10. doi: 10.1001/jamapediatrics.2016.2016. [Epub ahead of print]
2. Cost-effectiveness of newborn screening for congenital cytomegalovirus infection (JAMA Pediatrics) . The JAMA Network website. Available at: http://jamanetwork.com/learning/audio-player/13563392.  October 10, 2016. Accessed October 14, 2016.