Saito Hiroki, Sakai Kotomi, Tanaka Motoko, Konomura Keiko, Suzuki Mitsuyoshi, Tajima Go, Hoshino Eri
Department of Pediatrics, Faculty of Medicine, Juntendo University, Tokyo, Japan.
Department of Research, Heisei Medical Welfare Group Research Institute, Tokyo, Japan.
Eur J Pediatr. 2025 Jan 9;184(1):123. doi: 10.1007/s00431-024-05953-1.
This systematic review analyzes economic evaluations of newborn screening for congenital cytomegalovirus (cCMV) infection to identify key factors influencing cost-effectiveness and differences in methodological approaches.
Following a pre-registered PROSPERO protocol (CRD42023441587), we conducted a comprehensive literature search across multiple databases on July 4, 2024. The review included both full economic evaluations (cost and outcomes) and partial economic evaluations (cost only). Two reviewers independently performed data extraction and synthesis. Quality assessment used the Consensus Health Economic Criteria extended checklist and the Consolidated Health Economic Evaluation Reporting Standards 2022 Statement.
From 543 records, nine studies met inclusion criteria: four full and five partial economic evaluations. Two full economic evaluations provided the incremental cost-effectiveness ratio per quality-adjusted life year. Full economic evaluations using decision trees and Markov models generally found universal screening more cost-effective than targeted screening, despite higher incremental costs. Partial evaluations focused on direct costs, with varying inclusion of long-term care costs. Most studies adopted a healthcare system perspective, excluding indirect costs. Quality assessment of full economic evaluations revealed high methodological standards but identified common limitations in outcome measurement and reporting.
Available evidence suggests potential cost-effectiveness of newborn cCMV screening, particularly with early intervention strategies. However, limited full economic evaluations and heterogeneous methodological approaches preclude definitive conclusions, highlighting the need for additional research across diverse healthcare contexts.
• Congenital cytomegalovirus (cCMV) infection is a condition that can be detected through newborn screening, and understanding its economic implications is important for healthcare systems. • Economic evaluations can be categorized into full evaluations (analyzing both costs and outcomes) and partial evaluations (focusing only on costs).
• Based on a systematic review of 543 records, universal screening appears more cost-effective than targeted screening for cCMV, implementation challenges and healthcare system variations significantly impact its practical adoption. • The review identified significant methodological limitations in existing studies, particularly in outcome measurement and reporting, highlighting the need for more comprehensive research across different healthcare contexts.
本系统评价分析了先天性巨细胞病毒（cCMV）感染新生儿筛查的经济学评价，以确定影响成本效益的关键因素以及方法学方法的差异。
按照预先注册的PROSPERO方案（CRD42023441587），我们于2024年7月4日在多个数据库中进行了全面的文献检索。该评价包括完整的经济学评价（成本和结果）和部分经济学评价（仅成本）。两名评价员独立进行数据提取和综合分析。质量评估使用了共识卫生经济标准扩展清单和《2022年卫生经济评价报告标准合并声明》。
从543条记录中，有9项研究符合纳入标准：4项完整的和5项部分的经济学评价。两项完整的经济学评价提供了每质量调整生命年的增量成本效益比。使用决策树和马尔可夫模型的完整经济学评价通常发现，尽管增量成本较高，但普遍筛查比目标筛查更具成本效益。部分评价侧重于直接成本，对长期护理成本的纳入情况各不相同。大多数研究采用医疗保健系统视角，排除了间接成本。对完整经济学评价的质量评估显示方法学标准较高，但在结果测量和报告方面发现了常见的局限性。
现有证据表明新生儿cCMV筛查具有潜在的成本效益性，特别是采用早期干预策略时。然而，完整的经济学评价有限且方法学方法各异，无法得出确定性结论，这凸显了在不同医疗保健环境中进行更多研究的必要性。
• 先天性巨细胞病毒（cCMV）感染是一种可通过新生儿筛查检测出来的疾病，了解其经济影响对医疗保健系统很重要。• 经济学评价可分为完整评价（分析成本和结果）和部分评价（仅关注成本）。
• 基于对543条记录的系统评价，cCMV普遍筛查似乎比目标筛查更具成本效益，实施挑战和医疗保健系统差异对其实际应用有重大影响。• 该评价发现现有研究存在重大方法学局限性，特别是在结果测量和报告方面，这凸显了在不同医疗保健环境中进行更全面研究的必要性。
