Abstract
Purpose
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.
Methods
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.
Findings
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.
Implications
cCMVi was associated with substantial increases in HCRU and economic burden during
early childhood, and particularly during the first year of life.
Keywords
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Article info
Publication history
Published online: February 01, 2022
Accepted:
December 16,
2021
Identification
Copyright
© 2022 Elsevier Inc.
