2017 Sec 1 Green Book

Reprinted by permission of Int J Pediatr Oto rhino laryngol. 2015; 79(12):2090-2093.

International

Journal

of Pediatric Otorhinolaryngology 79

(2015)

2090–2093

Contents

lists

available

at ScienceDirect

International

Journal

of Pediatric Otorhinolaryngology

jour nal

homepage:

www.elsevier .com/locat e/ijpo r l

Cost–benefit

analysis

of

targeted

hearing

directed

early

testing

for

congenital

cytomegalovirus

infection

Bergevin a ,

Zick b , * ,

Browning McVicar c ,

Park d

Anna

Cathleen D.

Stephanie

Albert H.

a Center

for

Public

Policy &

Administration, University

of Utah,

Salt

Lake

City, UT, United

States

b Department

of

Family &

Consumer

Studies, University City, UT, United

of Utah,

Salt

Lake

City, UT, United

States

c Utah Department

of Health,

Salt

Lake

States

d Division

of Otolaryngology—Head

and Neck

Surgery, University

of Utah,

Salt

Lake

City, UT, United

States

A

R

T

I

C

L

E

I

N

F

O

A

B

S

T

R

A

C

T

Article

history:

In this study, we estimate an ex ante cost–benefit analysis of a Utah

law directed at

improving

Objectives:

Received Received Accepted Available

29

June

2015

cytomegalovirus

(CMV)

detection.

early

in

revised

form

12

September

2015

Study design: We use

a differential

cost of

treatment

analysis

for publicly

insured CMV-infected

infants

14

September

2015

by

a

statewide

hearing-directed

CMV

screening

program.

detected Methods:

online

25

September

2015

Utah government administrative data and multi-hospital accounting data are used

to estimate

compare

costs

and

benefits

for

the Utah

infant

population.

and

Keywords: Cytomegalovirus Sensorineural

If

antiviral

treatment

succeeds

in mitigating

hearing

loss

for

one

infant

per

year,

the

public

Results:

offset

the

public

costs

incurred

by

screening

and

treatment.

If

antiviral

treatment

is

not

savings will successful, accelerated Conclusions: significant

hearing

loss

the

program

represents

a

net

cost,

but

may

still

have

non-monetary

benefits

such

as

analysis

Cost–benefit

achievement

of

diagnostic milestones.

The

CMV

education

and

treatment

program

costs

are

modest

and

show

potential

for

cost

savings.

2015

Elsevier

Ireland

Ltd.

All

rights

reserved.

1. Introduction

also

reported

that

early

antiviral

intervention may

improve CMV-

hearing

and

neurocognitive

outcomes

[10] .

The

National Antiviral

related

(CMV)

is

the most common

infectious cause of

of

Allergy

and

Infectious Disease

Collaborative

Institute

Cytomegalovirus

sensorineural

hearing

loss

(SNHL)

[1] . Morton

et

al.,

(CASG) presented

results comparing 6 weeks versus 6

congenital

Study Group

reported

that 15–30% of pediatric

of

oral

valganciclovir

(VGC)

therapy

for

CMV

infected

Grosse et al., and our group have

months children

loss

can be

attributed

to CMV

[2–4] .

The

consequences

of

less

than

one

month

of

age.

Specifically, therapy had

64%

of

the

hearing hearing

loss

for

affected

children

include

speech

and

language

improved or

children who underwent 6 weeks of VGC

low

education,

and

poor

occupational

performance

in

versus 77% who underwent 6 months of

oral VGC outcomes

delay,

normal hearing

[5] .

The

lifetime

cost

for

each

child with hearing

loss

is

These

better

audiologic congenitally

and

neurocognitive

adulthood estimated

therapy.

to

be

over

three

hundred

thousand

dollars

accounting

to

symptomatic

infected

infants, however,

and

apply

the

lost productivity,

the need

for

special education, vocational

not

apply from

to

the

CMV

infected

hearing

impaired

infants

for

may

assistive

devices

and medical

costs

[6] . One

study

a

hearing

targeted

early

CMV

approach

[10] .

rehabilitation,

identified

the total costs associated with congenital CMV

infection

critical

challenge

in

diagnosing

congenital

CMV

is

that most

estimates

A

be

$4

billion

a

year

[7] .

Preventing

the

sequelae

of

progressive

infection. The diagnosis

to

newborns do not present with any signs of

loss would

significantly

reduce

the

personal

and

societal

laboratory

testing

of

neonatal

samples infection should be

within

the

first

hearing

requires

for

these

children.

life

since postnatal CMV

is not

associated

costs

three weeks of

has

shown

that

early

identification

and

intervention

SNHL. Thus,

ideally,

at-risk

infants

identified

early

Research

with

the

hearing-impaired

infant

reaches

6 months

of

age

are

permit

targeted monitoring

and

intervention

so

that

they

can

before

to

with

better

language

outcomes

[8,9] .

A

recent

paper

normal

speech

and

language

skills. One

testing

approach

associated

achieve utilizes

a

targeted

hearing

loss

driven

screening

method

to

which

infants

should

undergo

CMV

testing.

This

determine

the basis of a bill Representative Ronda Menlove,

approach became

* Corresponding

author.

Tel.:

+1

801

581

3147;

fax:

+1

801

581

5156.

introduced

to the

with the support of the Utah CMVworking group,

zick@fcs.utah.edu

(C.D.

Zick).

address:

E-mail

http://dx.doi.org/10.1016/j.ijporl.2015.09.019 0165-5876/ 2015 Elsevier Ireland Ltd. All

rights

reserved.

115