Screening and treating for primary cytomegalovirus infection in pregnancy: where do we stand? A decision-analytic and economic analysis

OBJECTIVE: To estimate which 1 of 3 screening strategies for primary maternal cytomegalovirus infection, with intention to treat with hyperimmune globulin, is most cost-effective. STUDY DESIGN: A decision-analytic and cost-effectiveness model was constructed for pregnant women, comparing 3 strategies screening for primary maternal cytomegalovirus infection with intention to treat with cytomegalovirus-intravenous immune globulin: ( 1) serum screen all pregnant women, ( 2) serum screen women with risk factors for primary cytomegalovirus, ( 3) serum screen women with suspicious sonographic findings. Probability, use ( or value), and cost estimates were derived from published literature. RESULTS: Universal screening for primary maternal cytomegalovirus was the preferred and most cost-effective strategy. However, if treatment with cytomegalovirus-intravenous immune globulin achieved less than a 47% reduction ( relative risk, 0.53) in clinical disease, universal screening would no longer be cost-effective. CONCLUSION: Universal screening for primary maternal cytomegalovirus infection is cost-effective based on available evidence, highlighting the urgent need for additional study evaluating the efficacy of cytomegalovirus-intravenous immune globulin to prevent congenital cytomegalovirus.