Abstract
BackgroundCongenital Toxoplasmosis (CT) can have severe consequences. France, Austria, and Slovenia have prenatal screening programs whereas some other countries are considering universal screening to reduce congenital transmission and severity of infection in children. The efficiency of such programs is debated increasingly as seroprevalence among pregnant women and incidence of congenital toxoplasmosis show a steady decrease. In addition, uncertainty remains regarding the effectiveness of pre- and postnatal treatments.MethodTo identify cost-effective strategies, prenatal and neonatal screenings were compared using a decision-analytic model based on French guidelines and current knowledge of long-term evolution of the disease in treated children. Epidemiological data were extracted from the scientific literature and clinical data from the French Lyon cohort. Strategies were compared at one year of age, when infection can be definitively evaluated, and at 15 years of age, after which validated outcome data become scarce. The analysis was performed from the French Health Insurance System perspective and included direct medical costs for pregnant women and their children.ResultsThe 1-year Incremental Cost-Effectiveness Ratio showed that prenatal screening would require investing €14,826 to avoid one adverse event (liveborn with CT, fetal loss, neonatal death or pregnancy termination) compared to neonatal screening. Extra investment increased up to €21,472 when considering the 15-year endpoint.ConclusionsPrenatal screening is cost-effective as compared to neonatal screening in moderate prevalence areas with predominant Type II strains. In addition, prenatal screening, by providing closer follow-up of women at risk increases the number of occasions for education avoiding toxoplasmosis.
Highlights
Toxoplasmosis is one of the most frequent zoonoses globally [1]
The 1-year Incremental Cost-Effectiveness Ratio showed that prenatal screening would require investing €14,826 to avoid one adverse event compared to neonatal screening
Prenatal screening is cost-effective as compared to neonatal screening in moderate prevalence areas with predominant Type II strains
Summary
Toxoplasmosis is one of the most frequent zoonoses globally [1]. Human infection with Toxoplasma gondii (T gondii) occurs through ingestion of oocysts shed by cats that contaminate raw fruits and vegetables or water, and through accidental ingestion of tissue cysts in raw or undercooked meat [2]. Retinochoroiditis, may occur any time after birth in all subjects with congenital toxoplasmosis (CT) [6]. Such ocular lesions were reported is in as many as 80% of untreated infected children [3]. Austria, and Slovenia have prenatal screening programs whereas some other countries are considering universal screening to reduce congenital transmission and severity of infection in children. The efficiency of such programs is debated increasingly as seroprevalence among pregnant women and incidence of congenital toxoplasmosis show a steady decrease. Uncertainty remains regarding the effectiveness of pre- and postnatal treatments
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