Cahill Alison G, Odibo Anthony O, Stamilio David M, Macones George A
Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA.
Am J Obstet Gynecol. 2009 Nov;201(5):466.e1-7. doi: 10.1016/j.ajog.2009.07.056. Epub 2009 Sep 26.
To estimate which 1 of 3 screening strategies for primary maternal cytomegalovirus infection, with intention to treat with hyperimmune globulin, is most cost-effective.
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.
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.
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.
评估三种原发性孕妇巨细胞病毒感染筛查策略中，哪一种在使用高效价免疫球蛋白进行治疗时最具成本效益。
为孕妇构建了一个决策分析和成本效益模型，比较三种针对原发性孕妇巨细胞病毒感染并打算使用巨细胞病毒静脉注射免疫球蛋白进行治疗的筛查策略：（1）对所有孕妇进行血清筛查；（2）对有原发性巨细胞病毒感染风险因素的女性进行血清筛查；（3）对超声检查结果可疑的女性进行血清筛查。概率、使用（或价值）和成本估计均来自已发表的文献。
对原发性孕妇巨细胞病毒进行普遍筛查是首选且最具成本效益的策略。然而，如果使用巨细胞病毒静脉注射免疫球蛋白治疗使临床疾病减少不到47%（相对风险，0.53），普遍筛查将不再具有成本效益。
根据现有证据，对原发性孕妇巨细胞病毒感染进行普遍筛查具有成本效益，这突出了迫切需要进行更多研究来评估巨细胞病毒静脉注射免疫球蛋白预防先天性巨细胞病毒感染的疗效。
