Universal Screening is Cost Effective for Congenital Cytomegalovirus Infection in China

Screening for congenital cytomegalovirus infection (cCMVi) may be a cost-effective addition to existing newborn screenings to prevent childhood hearing loss, a new study from China suggests.

The study, published in JAMA Network Open, used a Markov model to compare no screening, targeted screening of newborns who fail a hearing screening and universal screening for cCMVi, which has an incidence of about 0.7% among newborns in China.

“This evaluation demonstrated that universal screening could be cost-saving and more effective compared with targeted screening or no screening,” the study authors concluded. “Many children with cCMVi in China could benefit each year from newborn CMV screening, early detection, and interventions. The results presented in this study could be used by Chinese policymakers to make an informed decision about the scale-up of universal screening programs.”

Led by investigators at Nantong University, the study found that targeted screening, which would identify an estimated 41% of cCMVi cases needing antiviral treatment, could reduce the number of cases of childhood hearing loss by 820 each year while universal screening could reduce the number of childhood hearing loss cases by 2316.

Incremental cost-effectiveness ratios were $79 per quality-adjusted life-year (QALY) gained for targeted screening and $2087 for universal screening at the discounted rate of 3.5%.

Targeted screening increased QALYs by 38,415 and costs by $3,034,380 compared with universal screening, which increased QALYs by 126,540 and total costs by $264,114,150.

“Both screening options were cost-effective for the Chinese health care system based on the willingness-to-pay threshold of 3 × gross domestic product per capita,” the authors wrote. “The sensitivity analysis showed that the prevalence of cCMVi, as well as diagnosis and treatment costs, were key factors that may be associated with decision-making.”

The study included only direct medical costs. Further research could evaluate the indirect costs associated with hearing loss, such as productivity losses, which are estimated to be 2 to 5 times the amount direct costs.

“Whether to roll out universal screening or first implement targeted screening before scaling it to universal screening could depend on the geosocioeconomic gap among the Chinese provinces,” the authors wrote. “This is necessary, given that there is a substantial regional diversity in China regarding the coverage of PCR laboratories and cochlear implant surgery.”

The model could be adapted for other countries.

A similar study led by Soren Gannt, MD, PhD, MPH, and published in JAMA Pediatrics in 2016 suggested that targeted or universal screenings of newborns for cCMVi would be cost effective in the United States.

Last year, a study presented at IDWeek 2019 found that use of newborn dried blood spot (DBS) was not sensitive enough to detect all cases of cCMVi, noting that universal screening at birth would be a better method. It found that DBS testing of 54 infants with known cCMV was positive in only 68% of cases.

In 2018, the U.S. Food and Drug Administration approved a new test to detect cCMVi in newborns under 21 days old. The Alethia CMV Assay Test System can detect cCMVi from a saliva swab.

According to the U.S. Centers for Disease Control and Prevention, cytomegalovirus is common, infecting about a third of children by age 5 and half of adults by age 40. While most people experience no symptoms of the lifelong infection, infants and people with weakened immune systems can have serious symptoms, with hearing loss being the most common long-term health problem in babies.