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Cost–benefit analysis of targeted hearing directed early testing
for congenital cytomegalovirus infection
Anna Bergevin a, Cathleen D. Zick b, *, Stephanie Browning McVicar c, Albert H. Park d
a Center for Public Policy & Administration, University of Utah, Salt Lake City, UT, United States
b Department of Family & Consumer Studies, University of Utah, Salt Lake City, UT, United States
c Utah Department of Health, Salt Lake City, UT, United States
d Division of Otolaryngology—Head and Neck Surgery, University of Utah, Salt Lake City, UT, United States
1. Introduction
Cytomegalovirus (CMV) is the most common infectious cause of
congenital sensorineural hearing loss (SNHL) [1]. Morton et al.,
Grosse et al., and our group have reported that 15–30% of pediatric
hearing loss can be attributed to CMV [2–4]. The consequences of
hearing loss for affected children include speech and language
delay, low education, and poor occupational performance in
adulthood [5]. The lifetime cost for each child with hearing loss is
estimated to be over three hundred thousand dollars accounting
for the lost productivity, the need for special education, vocational
rehabilitation, assistive devices and medical costs [6]. One study
estimates the total costs associated with congenital CMV infection
to be $4 billion a year [7] . Preventing the sequelae of progressive
hearing loss would significantly reduce the personal and societal
costs for these children.
Research has shown that early identification and intervention
before the hearing-impaired infant reaches 6 months of age are
associated with better language outcomes [8,9]. A recent paper
also reported that early antiviral intervention may improve CMV-
related hearing and neurocognitive outcomes [10]. The National
Institute of Allergy and Infectious Disease Collaborative Antiviral
Study Group (CASG) presented results comparing 6 weeks versus 6
months of oral valganciclovir (VGC) therapy for CMV infected
children less than one month of age. Specifically, 64% of the
children who underwent 6 weeks of VGC therapy had improved or
normal hearing versus 77% who underwent 6 months of oral VGC
therapy. These better audiologic and neurocognitive outcomes
apply to symptomatic congenitally infected infants, however, and
may not apply to the CMV infected hearing impaired infants
identified from a hearing targeted early CMV approach [10].
A critical challenge in diagnosing congenital CMV is that most
newborns do not present with any signs of infection. The diagnosis
requires laboratory testing of neonatal samples within the first
three weeks of life since postnatal CMV infection is not associated
with SNHL. Thus, ideally, at-risk infants should be identified early
to permit targeted monitoring and intervention so that they can
achieve normal speech and language skills. One testing approach
utilizes a targeted hearing loss driven screening method to
determine which infants should undergo CMV testing. This
approach became the basis of a bill Representative Ronda Menlove,
with the support of the Utah CMVworking group, introduced to the
A R T I C L E I N F O
Article history:
Received 29 June 2015
Received in revised form 12 September 2015
Accepted 14 September 2015
Available online 25 September 2015
Keywords:
Cytomegalovirus
Sensorineural hearing loss
Cost–benefit analysis
A B S T R A C T
Objectives: In this study, we estimate an ex ante cost–benefit analysis of a Utah law directed at improving
early cytomegalovirus (CMV) detection.
Study design: We use a differential cost of treatment analysis for publicly insured CMV-infected infants
detected by a statewide hearing-directed CMV screening program.
Methods: Utah government administrative data and multi-hospital accounting data are used to estimate
and compare costs and benefits for the Utah infant population.
Results: If antiviral treatment succeeds in mitigating hearing loss for one infant per year, the public
savings will offset the public costs incurred by screening and treatment. If antiviral treatment is not
successful, the program represents a net cost, but may still have non-monetary benefits such as
accelerated achievement of diagnostic milestones.
Conclusions: The CMV education and treatment program costs are modest and show potential for
significant cost savings.
2015 Elsevier Ireland Ltd. All rights reserved.
* Corresponding author. Tel.: +1 801 581 3147; fax: +1 801 581 5156.
E-mail address: (C.D. Zick).
Contents lists available at
International Journal of Pediatric Otorhinolaryngology
jour nal homepage:
0165-5876/ 2015 Elsevier Ireland Ltd. All rights reserved.
Reprinted by permission of Int J Pediatr Otorhinolaryngol. 2015; 79(12):2090-2093.
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