Weil Clara, Wang Wei Vivian, Marks Morgan A, Bilavsky Efraim, Sinha Anushua, Chodick Gabriel, Goodman Elizabeth
Maccabi Institute for Research & Innovation (Maccabitech), Maccabi Healthcare Services, Tel Aviv, Israel.
Center for Observational and Real-World Evidence, Merck & Co Inc, Kenilworth, New Jersey.
Clin Ther. 2022 Feb;44(2):282-294. doi: 10.1016/j.clinthera.2021.12.007. Epub 2022 Feb 1.
Congenital cytomegalovirus infection (cCMVi) is the leading cause of nonhereditary sensorineural hearing loss and can cause other long-term neurodevelopmental disabilities; however, data on the economic burden of cCMVi during early childhood are scarce. The primary objective of the study was to describe longitudinal patterns of health care resource utilization (HCRU) and direct medical costs among infants with cCMVi compared to infants unexposed to cCMVi.
A retrospective cohort study was performed using data on infants born between 2013 and 2017, as captured in the database of Maccabi Healthcare Services, a 2.5 million-member health care organization in Israel. cCMVi cases were identified by physician diagnosis and/or dispensed valganciclovir within 90 days after birth. Infants born to mothers CMV-seronegative throughout pregnancy were selected for comparison (unexposed controls). Infants were retrospectively followed up through December 31, 2018, or 4 years of age (Y4). HCRU included physician visits, hospital admissions, audiology tests/procedures, imaging, and valganciclovir treatment. Direct medical costs, in US dollars per person per year (USD PPPY) were calculated from the health-system perspective. To compare costs of cCMVi cases and controls, direct medical costs were estimated using a generalized linear model with a log link function and γ distribution after adjustment for patient characteristics.
A total of 351 cCMVi cases and 11,733 control infants with continuous follow-up during their first year of life (Y1) were included in the study. In Y1, cases were more likely to have a hospital admission (8.5% cases vs 4.5% control; P < 0.001) and higher numbers of pediatrician visits (median, 18 vs 15), audiology visits and tests, and cranial ultrasounds (all, P < 0.05). Longitudinally, incremental costs associated with cases were highest in Y1 (1686.7 USD PPPY; cost ratio = 2.6; P < 0.001) and remained elevated through Y4.
cCMVi was associated with substantial increases in HCRU and economic burden during early childhood, and particularly during the first year of life.
先天性巨细胞病毒感染（cCMVi）是导致非遗传性感音神经性听力损失的主要原因，并且会引发其他长期神经发育障碍；然而，关于幼儿期cCMVi经济负担的数据却很稀少。本研究的主要目的是描述与未接触cCMVi的婴儿相比，cCMVi婴儿的医疗资源利用（HCRU）和直接医疗费用的纵向模式。
利用以色列一家拥有250万会员的医疗保健机构Maccabi医疗服务数据库中2013年至2017年出生婴儿的数据进行了一项回顾性队列研究。通过医生诊断和/或在出生后90天内使用缬更昔洛韦来确定cCMVi病例。选择整个孕期母亲CMV血清学阴性的婴儿作为对照（未接触对照组）。对婴儿进行回顾性随访至2018年12月31日或4岁（4岁）。HCRU包括医生诊疗、住院、听力测试/检查、影像学检查和缬更昔洛韦治疗。从卫生系统角度计算每人每年的直接医疗费用（美元购买力平价）。为了比较cCMVi病例和对照的费用，在对患者特征进行调整后，使用具有对数链接函数和γ分布的广义线性模型估计直接医疗费用。
共有351例cCMVi病例和11733例在生命第一年（1岁）接受持续随访的对照婴儿纳入研究。在1岁时，病例组更有可能住院（病例组8.5% vs对照组4.5%；P<0.001），儿科医生诊疗次数更多（中位数分别为18次和15次），听力诊疗和检查以及头颅超声检查次数也更多（均P<0.05）。纵向来看，病例组相关的增量费用在1岁时最高（1686.7美元购买力平价；费用比=2.6；P<0.001），并且在4岁前一直居高不下。
cCMVi与幼儿期尤其是生命第一年的HCRU大幅增加和经济负担有关。
