A study in JAMA Pediatrics shows that screening newborn babies for congenital cytomegalovirus (CMV) infection is cost-effective and helps prevent lifelong disabilities. The work was led by Dr. Soren Gantt, an Investigator at BC Children’s Hospital, an agency of the Provincial Health Services Authority, and an Associate Professor in the Department of Pediatrics at the University of British Columbia.
CMV is a common virus that can spread from mothers to fetuses during pregnancy and results in serious health problems in children, including hearing loss and developmental delay. Around 50 per cent of adults carry CMV, but most will never know they’re infected because the virus doesn’t usually cause symptoms in healthy adults.
There is currently no vaccine to prevent CMV, but early diagnosis of babies with congenital infection can reduce lifelong health impacts. Congenital CMV can be diagnosed by testing a baby’s saliva at birth, and affected babies can receive an antiviral drug that have been shown to improve their hearing and neurodevelopmental outcomes. By diagnosing CMV as early as possible, newborn screening programs can reduce the incidence of severe to profound hearing loss by 4 -13 per cent, depending on the type of screening program and the number of infected babies who receive treatment. Because babies with congenital CMV infection usually don’t have obvious symptoms at birth, without a newborn screening program most go undiagnosed and don’t receive optimal care.
On the other hand, around 80 per cent of babies who have CMV will not suffer lasting health effects, leading to concerns that screening programs might generate unnecessary costs by identifying babies who would be fine without any intervention. In this study, researchers sought to determine whether the costs savings from preventing CMV-related disabilities offset the costs of implementing screening programs and treating all children who test positive.
Researchers studied the outcomes of CMV screening programs for newborns at hospitals in the United States. They looked at both universal screening programs, in which all newborns are tested for CMV, and targeted screening programs, in which only babies who fail newborn hearing tests are screened.
According to the economic analysis performed by the researchers, the cost of identifying one case of congenital CMV depends on the program used, and ranges from $2,000 to $10,000 USD (U.S. dollars) through universal screening or $566 to $2,833 USD through targeted screening. Screening programs resulted in a net savings for the healthcare system of approximately $21 - $32 USD per newborn for universal screening or $11 - $27 USD per newborn for targeted screening by reducing lifelong costs for therapies and loss of productivity due to CMV-related health problems and disabilities.
“Both universal and targeted screening programs are medically beneficial, but concerns about cost have been a barrier to implementation,” say Dr. Gantt.
“Our study shows both types of screening programs are cost-effective, and we hope this will lead to the introduction of more programs across North America.”
In May 2016, a newborn CMV screening program was launched at BC Women’s Hospital that provides CMV screening for all babies who fail the newborn hearing test or who are in the neonatal intensive care unit. This program was developed through a collaboration between the BC Early Hearing Program, BC Children’s Hospital, and BC Women’s Hospital, and is the first clinical screening program for congenital CMV in Canada.
Dr. Gantt hopes this research will increase public awareness about congenital CMV infection. Over 200 babies are born with CMV in BC every year and about 20 per cent will develop hearing loss. “CMV is the most important infection most people have never heard of,” says Dr. Gantt.
This research was supported by BC Children’s Hospital Foundation, the Canadian Institutes of Health Research, the National Institute on Deafness and Other Communication Disorders, and the National Institute of Allergy and Infectious Disease.
Study co-authors include:
Dr. David Goldfarb – Investigator and Medical Microbiologist, BC Children’s Hospital; Clinical Associate Professor, Department of Pathology & Laboratory Medicine, University of British Columbia
Dr. Fred Kozack – Investigator, BC Children’s Hospital; Clinical Professor, Department of Surgery, University of British Columbia
Gantt, S. et al. Cost-effectiveness of Universal and Targeted Newborn Screening for Congenital Cytomegalovirus Infection. JAMA Pediatrics (2016)