620: Universal cytomegalovirus screening in pregnancy: a cost-effectiveness analysis

To determine necessary effectiveness of intravenous Immunoglobulin (IVIG) to prevent congenital cytomegalovirus (CMV) and threshold seroprevalence of CMV to make universal CMV screening in pregnancy cost-effective. Decision analysis to compare te cost-effectiveness of two strategies for prevention and treatment of congenital CMV: universal maternal serum screening and routine care. The probability of primary CMV is assumed to be 1% of seronegative women (range 0 -4%). Additional assumptions include: all screen-positive women receive monthly IVIG, screen-negative women receive behavioral counseling presumed to be effective at decreasing CMV seroconversion, and women may terminate a pregnancy under a variety of conditions. The primary outcome is cost per neonatal quality adjusted life year (QALY) gained with a willingness to pay of $100,000 per QALY gained. In the base case, routine care is cost saving compared to universal screening, costing $4,820 less per QALY gained. Over all possible ranges of CMV seroprevalence and IVIG treatment effect, universal screening is never cost-effective. In sensitivity analyses, the model is most sensitive to the rate of termination after a positive serum screen, an inherent limitation of cost-effectiveness analyses as termination leads to a neonatal QALY of zero. In women who continue pregnancy, universal screening is cost-effective ($31,165/QALY gained). Under these conditions, universal screening remains cost-effective if seroprevalence is >0.42% and IVIG reduces the fetal infection risk by ≥30%. Additionally, greater reduction in seroconversion with behavioral counseling allows universal screening to remain cost-effective at lower rates of primary CMV (Figure). In women who continue pregnancy, universal screening is cost-effective if IVIG is efficacious and seroprevalence of primary CMV adequately high. The addition of behavioral counseling, if efficacious, allows universal screening to be cost-effective at lower rates of primary CMV infection.