RESUMEN
BACKGROUND AND OBJECTIVES: Cytomegalovirus (CMV) is the most common congenital infection and nongenetic cause of congenital sensorineural hearing loss in the United States. Utah was the first state to pass legislation mandating CMV screening for newborns who fail newborn hearing screening (NBHS). The study objective was to present outcomes of hearing-targeted CMV screening and determine factors predicting CMV screening. METHODS: We used Utah Department of Health HiTrack and Vital Records databases to examine CMV screening from 509 infants who failed NBHS in the 24 months after implementation of the Utah legislation. Multivariate logistic regression analyses were conducted to identify predictors of compliance with CMV screening and diagnostic hearing evaluation. RESULTS: Sixty-two percent of infants who never passed hearing screening underwent CMV screening. Fourteen of 234 infants tested within 21 days were CMV positive; 6 (42.9%) had hearing loss. Seventy-seven percent of eligible infants completed a diagnostic hearing evaluation within 90 days of birth. Compliance with CMV screening was associated with sociodemographic factors, time since the law was enacted, and NBHS protocol. Infants born after the legislation showed greater odds of achieving timely diagnostic hearing evaluation than infants born before the law. CONCLUSIONS: Incorporating CMV screening into an established NBHS program is a viable option for the identification of CMV in infants failing NBHS. The addition of CMV testing can help a NBHS program attain timely audiological diagnostics within 90 days, an important early hearing detection and intervention milestone.
Asunto(s)
Infecciones por Citomegalovirus/diagnóstico , Pérdida Auditiva Sensorineural/diagnóstico , Pruebas Auditivas , Tamizaje Neonatal/legislación & jurisprudencia , Adulto , Bases de Datos Factuales , Diagnóstico Precoz , Escolaridad , Femenino , Pérdida Auditiva Sensorineural/congénito , Pérdida Auditiva Sensorineural/virología , Humanos , Recién Nacido , Medicaid , Madres , Análisis Multivariante , Hermanos , Padres Solteros , Estados Unidos , UtahRESUMEN
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.