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The cost-effectiveness of neonatal versus prenatal screening for congenital toxoplasmosis


Autoři: Christine Binquet aff001;  Catherine Lejeune aff001;  Valérie Seror aff003;  François Peyron aff005;  Anne-Claire Bertaux aff001;  Olivier Scemama aff007;  Catherine Quantin aff001;  Sophie Béjean aff010;  Eileen Stillwaggon aff012;  Martine Wallon aff005
Působiště autorů: INSERM, CIC1432, Module Epidémiologie Clinique, Dijon, France aff001;  Centre Hospitalier Universitaire Dijon-Bourgogne, Centre d’investigation Clinique, Module Épidémiologie Clinique/ Essais Cliniques, Dijon, France aff002;  Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France aff003;  IHU-Méditerranée Infection, Marseille, France aff004;  Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Institut de Parasitologie et de Mycologie Médicale, Institut des Agents Infectieux, Lyon, France aff005;  Centre Hospitalier Universitaire Dijon-Bourgogne, Délégation à la recherche Clinique et à l’Innovation, Unité de Soutien Méthodologique à la Recherche, Dijon, France aff006;  Haute Autorité de Santé, Service Evaluation Economique et Santé Publique, St Denis, France aff007;  Centre Hospitalier Universitaire Dijon-Bourgogne, Service de biostatistiques et d’informatique médicale, Dijon, France aff008;  INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Paris, France aff009;  Université de Bourgogne, Laboratoire d’économie de Dijon, Dijon, France aff010;  CNRS, UMR 6307, Dijon, France aff011;  Department of Economics, Gettysburg College, Gettysburg, Pennsylvania, United states of America aff012;  INSERM, U1028, Physiologie Intégrée du Système d’Eveil, Lyon, France aff013;  CNRS, UMR5292, Lyon, France aff014;  Université Lyon, Centre de Recherche en Neurosciences, Lyon, France aff015
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0221709

Souhrn

Background

Congenital Toxoplasmosis (CT) can have severe consequences. France, Austria, and Slovenia have prenatal screening programs whereas some other countries are considering universal screening to reduce congenital transmission and severity of infection in children. The efficiency of such programs is debated increasingly as seroprevalence among pregnant women and incidence of congenital toxoplasmosis show a steady decrease. In addition, uncertainty remains regarding the effectiveness of pre- and postnatal treatments.

Method

To identify cost-effective strategies, prenatal and neonatal screenings were compared using a decision-analytic model based on French guidelines and current knowledge of long-term evolution of the disease in treated children. Epidemiological data were extracted from the scientific literature and clinical data from the French Lyon cohort. Strategies were compared at one year of age, when infection can be definitively evaluated, and at 15 years of age, after which validated outcome data become scarce. The analysis was performed from the French Health Insurance System perspective and included direct medical costs for pregnant women and their children.

Results

The 1-year Incremental Cost-Effectiveness Ratio showed that prenatal screening would require investing €14,826 to avoid one adverse event (liveborn with CT, fetal loss, neonatal death or pregnancy termination) compared to neonatal screening. Extra investment increased up to €21,472 when considering the 15-year endpoint.

Conclusions

Prenatal screening is cost-effective as compared to neonatal screening in moderate prevalence areas with predominant Type II strains. In addition, prenatal screening, by providing closer follow-up of women at risk increases the number of occasions for education avoiding toxoplasmosis.

Klíčová slova:

Medicine and health sciences – Parasitic diseases – Protozoan infections – Toxoplasmosis – Women's health – Maternal health – Pregnancy – Pregnancy complications – Fetal death – Birth – Obstetrics and gynecology – Pediatrics – Pediatric infections – Biology and life sciences – Developmental biology – Neonates – Engineering and technology – Management engineering – Research and analysis methods – Decision analysis – Decision trees – Social sciences – Economics – Economic analysis – Cost-effectiveness analysis


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