PMID- 31532766 OWN - NLM STAT- MEDLINE DCOM- 20200309 LR - 20200309 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 14 IP - 9 DP - 2019 TI - The cost-effectiveness of neonatal versus prenatal screening for congenital toxoplasmosis. PG - e0221709 LID - 10.1371/journal.pone.0221709 [doi] LID - e0221709 AB - BACKGROUND: Congenital 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. METHOD: To 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. RESULTS: The 1-year Incremental Cost-Effectiveness Ratio showed that prenatal screening would require investing euro14,826 to avoid one adverse event (liveborn with CT, fetal loss, neonatal death or pregnancy termination) compared to neonatal screening. Extra investment increased up to euro21,472 when considering the 15-year endpoint. CONCLUSIONS: Prenatal 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. FAU - Binquet, Christine AU - Binquet C AUID- ORCID: 0000-0002-9417-5754 AD - INSERM, CIC1432, Module Epidemiologie Clinique, Dijon, France. AD - Centre Hospitalier Universitaire Dijon-Bourgogne, Centre d'investigation Clinique, Module Epidemiologie Clinique/ Essais Cliniques, Dijon, France. FAU - Lejeune, Catherine AU - Lejeune C AD - INSERM, CIC1432, Module Epidemiologie Clinique, Dijon, France. AD - Centre Hospitalier Universitaire Dijon-Bourgogne, Centre d'investigation Clinique, Module Epidemiologie Clinique/ Essais Cliniques, Dijon, France. FAU - Seror, Valerie AU - Seror V AD - Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France. AD - IHU-Mediterranee Infection, Marseille, France. FAU - Peyron, Francois AU - Peyron F AD - Hospices Civils de Lyon, Hopital de la Croix-Rousse, Institut de Parasitologie et de Mycologie Medicale, Institut des Agents Infectieux, Lyon, France. FAU - Bertaux, Anne-Claire AU - Bertaux AC AD - INSERM, CIC1432, Module Epidemiologie Clinique, Dijon, France. AD - Centre Hospitalier Universitaire Dijon-Bourgogne, Centre d'investigation Clinique, Module Epidemiologie Clinique/ Essais Cliniques, Dijon, France. AD - Centre Hospitalier Universitaire Dijon-Bourgogne, Delegation a la recherche Clinique et a l'Innovation, Unite de Soutien Methodologique a la Recherche, Dijon, France. FAU - Scemama, Olivier AU - Scemama O AD - Haute Autorite de Sante, Service Evaluation Economique et Sante Publique, St Denis, France. FAU - Quantin, Catherine AU - Quantin C AD - INSERM, CIC1432, Module Epidemiologie Clinique, Dijon, France. AD - Centre Hospitalier Universitaire Dijon-Bourgogne, Centre d'investigation Clinique, Module Epidemiologie Clinique/ Essais Cliniques, Dijon, France. AD - Centre Hospitalier Universitaire Dijon-Bourgogne, Service de biostatistiques et d'informatique medicale, Dijon, France. AD - INSERM, UVSQ, Institut Pasteur, Universite Paris-Saclay, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Paris, France. FAU - Bejean, Sophie AU - Bejean S AD - Universite de Bourgogne, Laboratoire d'economie de Dijon, Dijon, France. AD - CNRS, UMR 6307, Dijon, France. FAU - Stillwaggon, Eileen AU - Stillwaggon E AD - Department of Economics, Gettysburg College, Gettysburg, Pennsylvania, United states of America. FAU - Wallon, Martine AU - Wallon M AD - Hospices Civils de Lyon, Hopital de la Croix-Rousse, Institut de Parasitologie et de Mycologie Medicale, Institut des Agents Infectieux, Lyon, France. AD - INSERM, U1028, Physiologie Integree du Systeme d'Eveil, Lyon, France. AD - CNRS, UMR5292, Lyon, France. AD - Universite Lyon, Centre de Recherche en Neurosciences, Lyon, France. LA - eng PT - Comparative Study PT - Journal Article DEP - 20190918 PL - United States TA - PLoS One JT - PloS one JID - 101285081 SB - IM MH - Austria MH - Clinical Decision-Making MH - Cost-Benefit Analysis/*methods MH - Female MH - France MH - Humans MH - Infant, Newborn MH - Models, Theoretical MH - Neonatal Screening/*economics MH - Pregnancy MH - Prenatal Diagnosis/*economics MH - Slovenia MH - Toxoplasmosis, Congenital/*diagnosis/economics PMC - PMC6750576 COIS- The authors have declared that no competing interests exist. EDAT- 2019/09/19 06:00 MHDA- 2020/03/10 06:00 PMCR- 2019/09/18 CRDT- 2019/09/19 06:00 PHST- 2019/05/25 00:00 [received] PHST- 2019/08/13 00:00 [accepted] PHST- 2019/09/19 06:00 [entrez] PHST- 2019/09/19 06:00 [pubmed] PHST- 2020/03/10 06:00 [medline] PHST- 2019/09/18 00:00 [pmc-release] AID - PONE-D-19-14716 [pii] AID - 10.1371/journal.pone.0221709 [doi] PST - epublish SO - PLoS One. 2019 Sep 18;14(9):e0221709. doi: 10.1371/journal.pone.0221709. eCollection 2019.