1
|
Diaz-Decaro J, Myers E, Mucha J, Neumann M, Lewandowski W, Kaczanowska M, Schmidt E, Natenshon A, Talarico C, Buck PO. A systematic literature review of the economic and healthcare resource burden of cytomegalovirus. Curr Med Res Opin 2023; 39:973-986. [PMID: 37395088 DOI: 10.1080/03007995.2023.2222583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 05/22/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Cytomegalovirus (CMV) can infect individuals at any age, including infants, who may contract it from infected mothers (congenital CMV [cCMV]). Whereas CMV infection is typically asymptomatic or causes mild illness in healthy individuals, infection can result in severe outcomes in immunocompromised individuals and in infants with cCMV. This systematic review aims to characterize the economic impact of CMV and cCMV infections. METHODS Medline, Embase, and LILACS databases were searched for publications reporting the economic impact of cCMV and CMV infections across all age groups. Manuscripts published between 2010 and 2020 from Australia, Latin America, Canada, Europe, Israel, Japan, the United States, and global (international, worldwide) studies were included; congress materials were excluded. Outcomes of interest included cCMV- and CMV-attributable direct costs/charges, resource utilization, and indirect/societal costs. RESULTS Of 751 records identified, 518 were excluded based on duplication, population, outcome, study design, or country. Overall, 55 articles were eligible for full-text review; 25 were further excluded due to population, outcome, study design, or congress abstract. Two publications were additionally identified, resulting in economic impact data compiled from 32 publications. Of these, 24 publications reported cost studies of cCMV or CMV, including evaluation of direct costs/charges, healthcare resource utilization, and indirect/societal costs, and 7 publications reported economic evaluations of interventions. The populations, methods and outcomes used across these studies varied widely. CONCLUSIONS CMV and cCMV infections impose a considerable economic impact on different countries, populations, and outcomes. There are substantial evidence gaps where further research is warranted.
Collapse
Affiliation(s)
| | - Evan Myers
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Leung J, Kennedy JL, Haberling DL, Apostolou A, Lanzieri TM. Congenital CMV-Coded Diagnosis Among American Indian and Alaska Native Infants in the United States, 2000-2017. J Immigr Minor Health 2020; 22:1101-1104. [PMID: 32424641 PMCID: PMC8829881 DOI: 10.1007/s10903-020-01024-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To assess prevalence of congenital cytomegalovirus (CMV)-coded diagnosis among American Indian/Alaska Native (AI/AN) infants who received Indian Health Service (IHS)-funded care during 2000-2017. Using data from the Indian Health Service National Data Warehouse, we identified AI/AN infants with congenital CMV-coded diagnosis, defined as presence of a diagnostic code for congenital CMV disease or CMV infection (International Classification of Diseases, Ninth Revision or Tenth Revision, Clinical Modification 771.1, 078.5, P35.1, B25.xx) within 90 days of life. We calculated prevalence of congenital CMV-coded diagnosis overall, by age at first CMV-coded diagnosis, and by geographical region. During 2000-2017, 54 (1.5/10,000) of 354,923 AI/AN infants had a congenital CMV-coded diagnosis; 32 (0.9/10,000) had their first CMV-coded diagnosis within 45 days of life, and 22 (0.6/10,000) between 46 and 90 days of life. Prevalence of congenital CMV-coded diagnosis varied by region (range 0.9/10,000 in Southern Plains to 3.7/10,000 in Alaska, P = 0.0038). Among the 54 infants with a congenital CMV-coded diagnosis, 48% had clinical signs such as jaundice, petechiae, or microcephaly, compared to 25% of 354,869 infants without a CMV-coded diagnosis (P < 0.01); and 1 (2%) vs. 277 (0.1%), respectively, died (P < 0.05). The prevalence of congenital CMV-coded diagnosis among AI/AN infants who received care at IHS facilities was slightly lower than in other studies based on health claims data and varied by geographical region.
Collapse
Affiliation(s)
- Jessica Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS H24-5, Atlanta, GA, 30333, USA.
| | - Jordan L Kennedy
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dana L Haberling
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andria Apostolou
- Division of Epidemiology and Disease Prevention, Indian Health Service, Rockville, MD, USA
- SciMetrika, LLC, McLean, VA, USA
| | - Tatiana M Lanzieri
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS H24-5, Atlanta, GA, 30333, USA
| |
Collapse
|
3
|
Martin M, Holmes S, Sim J, Hassan M, Mathew R, Bensen R, Barakat M. Foregone Inclusion: Neonatal CMV Hepatitis and Cholestasis. Dig Dis Sci 2019; 64:3092-3095. [PMID: 31187327 DOI: 10.1007/s10620-019-05691-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Melissa Martin
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Lucille Packard Children's Hospital at Stanford, Stanford, CA, 94305, USA.
| | - Signy Holmes
- Division of Radiology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Jordan Sim
- Division of Pathology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Maheen Hassan
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Lucille Packard Children's Hospital at Stanford, Stanford, CA, 94305, USA
| | - Roshni Mathew
- Division of Pediatric Infectious Diseases, Lucille Packard Children's Hospital at Stanford, Stanford, CA, 94305, USA
| | - Rachel Bensen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Lucille Packard Children's Hospital at Stanford, Stanford, CA, 94305, USA
| | - Monique Barakat
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Lucille Packard Children's Hospital at Stanford, Stanford, CA, 94305, USA
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| |
Collapse
|
4
|
Tran C, Bennett MV, Gould JB, Lee HC, Lanzieri TM. Cytomegalovirus Infection among Infants in Neonatal Intensive Care Units, California, 2005 to 2016. Am J Perinatol 2019; 37:146-150. [PMID: 30895580 PMCID: PMC6754307 DOI: 10.1055/s-0039-1683958] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM The main purpose of this article is to assess trends in cytomegalovirus (CMV) infection reported among infants in California neonatal intensive care units (NICUs) during 2005 to 2016. STUDY DESIGN The California Perinatal Quality Care Collaborative collects data on all very low birth weight (VLBW, birth weight ≤ 1,500 g) and acutely ill infants > 1,500 g, representing 92% of NICUs in California. We compared clinical characteristics and length of hospital stay among infants with and without reported CMV infection (CMV-positive viral culture or polymerase chain reaction). RESULTS During 2005 to 2016, CMV infection was reported in 174 VLBW infants and 145 infants > 1,500 g, or 2.7 (range: 1.5-4.7) and 1.2 (range: 0.8-1.7) per 1,000 infants, respectively (no significant annual trend). Among infants > 1,500 g, 12 (8%) versus 4,928 (4%) of those reported with versus without CMV infection died (p < 0.05). The median hospital stay was significantly longer among infants reported with versus without CMV infection for both VLBW infants (98 vs. 46 days) and infants > 1,500 g (61 vs. 14 days) (p < 0.001). CONCLUSION Reports of CMV infection remained stable over a 12-year period. Although we were not able to assess whether infection was congenital or postnatal, CMV infection among infants > 1,500 g was associated with increased mortality.
Collapse
Affiliation(s)
- Chinh Tran
- University of California Irvine, School of Medicine, Irvine, CA,California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Mihoko V. Bennett
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA,Stanford University, School of Medicine, Stanford, CA
| | - Jeffrey B. Gould
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA,Stanford University, School of Medicine, Stanford, CA
| | - Henry C. Lee
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA,Stanford University, School of Medicine, Stanford, CA
| | - Tatiana M. Lanzieri
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
5
|
Risk Factors, Geographic Distribution, and Healthcare Burden of Symptomatic Congenital Cytomegalovirus Infection in the United States: Analysis of a Nationally Representative Database, 2000-2012. J Pediatr 2018; 199:118-123.e1. [PMID: 29706491 DOI: 10.1016/j.jpeds.2018.03.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/26/2018] [Accepted: 03/15/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess risk factors, geographic distribution, length of stay, and total charges per case of symptomatic congenital cytomegalovirus infection (cCMV). STUDY DESIGN We performed retrospective analyses of serial cross-sectional data using the Kids' Inpatient Database, a nationally representative sample of US pediatric hospital discharges, from 2000, 2003, 2006, 2009, and 2012. Symptomatic cCMV was identified via use of the International Classification of Diseases, Ninth Revision, Clinical Modification code 771.1 among records with in-hospital birth that were accompanied by 1 or more characteristic symptoms. Demographic characteristics were compared with multivariable logistic regression. Temporal trend was assessed using linear regression. Charges were adjusted for inflation to 2012 US dollars. RESULTS We identified 1349 cases of symptomatic cCMV (SE 56). Symptomatic cCMV was associated with non-Hispanic black race (OR 1.70; 95% CI 1.37-2.10), government-sponsored insurance (OR 1.95; 95% CI 1.34-2.83), and birth in the American South and West (OR 1.68, 95% CI 1.35-2.09 and OR 1.61, 95% CI 1.23-2.09, respectively). In-hospital mortality and preterm birth rate ranged from 3.2%-6.8% and 50.4%-59.2%, respectively, without temporal changes. The geometric mean of total charges per case doubled from $45 771 (SE $8509) in 2000 to $89 846 (SE $10 358) in 2006 (P = .002) but did not change from 2006 to 2012. Length of stay in days was 15 (IQR 8-22) in 2000, 27 (IQR, 9-51) in 2009, and 18 (IQR, 8-47) in 2012. CONCLUSIONS Symptomatic cCMV was associated with non-Hispanic black race, low socioeconomic status, and birth in the American South and West and resulted in substantial healthcare burden.
Collapse
|
6
|
Leung J, Dollard SC, Grosse SD, Chung W, Do T, Patel M, Lanzieri TM. Valganciclovir Use Among Commercially and Medicaid-insured Infants With Congenital CMV Infection in the United States, 2009-2015. Clin Ther 2018; 40:430-439.e1. [PMID: 29397198 DOI: 10.1016/j.clinthera.2018.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to assess the clinical characteristics and trends in valganciclovir use among infants diagnosed with congenital cytomegalovirus (CMV) disease in the United States. METHODS We analyzed data from medical claims dated 2009-2015 from the Truven Health MarketScan® Commercial Claims and Encounters and Medicaid databases. We identified infants with a live birth code in the first claim who were continuously enrolled for at least 45 days. Among infants diagnosed with congenital CMV disease, identified by an ICD-9-CM or ICD-10-CM code for congenital CMV infection or CMV disease within 45 days of birth, we assessed data from claims containing codes for any CMV-associated clinical condition within the same period, and data from claims for hearing loss and/or valganciclovir within the first 180 days of life. FINDINGS In the commercial and Medicaid databases, we identified 257 (2.5/10,000) and 445 (3.3/10,000) infants, respectively, diagnosed with congenital CMV disease, among whom 135 (53%) and 282 (63%) had ≥1 CMV-associated condition, 30 (12%) and 32 (7%) had hearing loss, and 41 (16%) and 78 (18%) had a claim for valganciclovir. Among infants with congenital CMV disease who had a claim for valganciclovir, 37 (90%) among commercially insured infants and 68 (87%) among Medicaid-insured infants had ≥1 CMV-associated condition and/or hearing loss. From 2009 to 2015, the percentages with a claim for valganciclovir increased from 0% to 29% among commercially insured infants and from 4% to 37% among Medicaid-insured infants (P < 0.0001). IMPLICATIONS During 2009-2015, there was a strong upward trend in valganciclovir claims among insured infants who were diagnosed with congenital CMV disease, the majority of whom had CMV-associated conditions and/or hearing loss.
Collapse
Affiliation(s)
- Jessica Leung
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Sheila C Dollard
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Winnie Chung
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - ThuyQuynh Do
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Manisha Patel
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tatiana M Lanzieri
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
7
|
Long-term outcomes of children with symptomatic congenital cytomegalovirus disease. J Perinatol 2017; 37:875-880. [PMID: 28383538 PMCID: PMC5562509 DOI: 10.1038/jp.2017.41] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/20/2017] [Accepted: 03/03/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess long-term outcomes of children with symptomatic congenital cytomegalovirus (CMV) disease detected at birth. STUDY DESIGN We used Cox regression to assess risk factors for intellectual disability (intelligence quotient <70), sensorineural hearing loss (SNHL; hearing level ⩾25 dB in any audiometric frequency) and vision impairment (best corrected visual acuity >20 or based on ophthalmologist report). RESULTS Among 76 case-patients followed through median age of 13 (range: 0-27) years, 56 (74%) had SNHL, 31 (43%, n=72) had intellectual disability and 18 (27%, n=66) had vision impairment; 28 (43%, n=65) had intellectual disability and SNHL with/without vision impairment. Microcephaly was significantly associated with each of the three outcomes. Tissue destruction and dysplastic growth on head computed tomography scan at birth was significantly associated with intellectual disability and SNHL. CONCLUSION Infants with symptomatic congenital CMV disease may develop moderate to severe impairments that were associated with presence of microcephaly and brain abnormalities.
Collapse
|
8
|
Cytomegalovirus infection and neonatal outcome in extremely preterm infants after freezing of maternal milk. Pediatr Infect Dis J 2015; 34:482-9. [PMID: 25879648 DOI: 10.1097/inf.0000000000000619] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) infection acquired from breast milk can cause serious illness in extremely preterm (EPT) infants (<28 weeks). Some neonatal centers freeze maternal milk (MM) to prevent CMV transmission; however, this practice is controversial. In this study, we assessed the CMV transmission rate and neonatal outcome in EPT infants after routine freezing of all MM. METHODS EPT infants (n = 140) and their mothers were randomized to the intervention group (only freeze-thawed MM) or the control group (combined fresh and freeze-thawed MM). Freeze-thawed MM was frozen at -20°C for ≥3 days before thawing. Mothers had serological tests for CMV, and MM was analyzed for CMV by polymerase chain reaction and CMV culture. Infants underwent CMV screening with urine analysis by CMV-polymerase chain reaction and CMV culture until 12 weeks of age. RESULTS Congenital CMV infection was detected in 2% of screened infants. The CMV transmission rate in infants fed with CMV-DNA positive milk was 8% (3 of 37) in the intervention group and 6% (2 of 33) in controls. All infants infected by CMV were asymptomatic. The final per-protocol analysis included 56 infants in the intervention group and 65 controls. Neonatal mortality was comparable between the groups (7% vs. 6%). Neonatal morbidity was similar, except for late onset Candida sepsis, which was more frequent in the controls (12% vs. 0%). CONCLUSIONS Routine freezing of all MM did not affect the rate of CMV transmission but may help to prevent fungal sepsis in EPT infants. This observation merits further investigation.
Collapse
|