O2073: Cost-effectiveness of Screening Strategies for Congenital Cytomegalovirus Infection: The U.S. Healthcare Perspective

Background: Identifying congenital cytomegalovirus (cCMV) infection in the newborn period offers the opportunity to mitigate hearing loss by treating infected newborns with valganciclovir. Our objective was to analyze the cost-effectiveness of three screening strategies (no screening, targeted saliva PCR screening triggered by failed newborn hearing screening, and universal saliva PCR screening) from the United States (U.S.) healthcare system perspective.

Methods: Cost-effectiveness was estimated using a decision-analysis model with parameters obtained from published literature. Costs were reported in 2022 U.S. dollars using a 3% discounting rate over the U.S. life expectancy. Effectiveness was assessed by quality adjusted life years (QALYs). Primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as cost per QALY gained using a $100,000/QALY willingness-to-pay (WTP) threshold. Deterministic sensitivity analyses (SA) and probabilistic Monte Carlo (MC) simulations were performed. Secondary outcome was incremental cost to prevent one case of moderate-to-severe CMV-related hearing loss.

Results: For the base case, the ICER of targeted screening versus no screening was cost-effective ($12,613/QALY). The ICER for universal screening versus targeted screening exceeded the commonly accepted ICER threshold ($164,305/QALY). Using one-way SA, the decision supporting targeted screening was robust to wide variation in model inputs. Targeted screening was the optimal decision in 84% of MC simulations. The cost to prevent one case of moderate-to-severe CMV-related hearing loss ranged from $190,531 (targeted screening) to $2,482,047 (universal screening).

Conclusion: Our model demonstrated that targeted newborn screening using saliva PCR is a cost-effective strategy to identify newborns with cCMV from the U.S. healthcare perspective. SA confirmed that the decision is robust to uncertainty. These findings support public policy initiatives to add targeted cCMV screening to the newborn screening panel.