{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T15:58:18Z","timestamp":1791388698603,"version":"4.3.3"},"reference-count":50,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Prenatal Diagnosis"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the cost\u2010effectiveness of first trimester single\u2010step universal cytomegalovirus (CMV) serological screening with valacyclovir as vertical transmission prophylaxis versus routine ultrasound\u2010directed testing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A payer perspective cost\u2010utility analysis was conducted on a hypothetical population of 100,000 pregnant women for a time horizon of 9\u00a0month of full\u2010term pregnancy and the lifetime of children. Using a decision\u2010tree and Markov model, we assessed quality\u2010adjusted life years (QALYs) gained by preventing congenital CMV (cCMV) sequelae against the costs of universal screening and valacyclovir prophylaxis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The ICER for universal screening strategy was USD125,864 (SGD170,087)\/QALY\u2010gained compared to routine ultrasound\u2010directed testing. It prevented approximately 54 cCMV infections, 18 cases of symptomatic infections, and 17 cases of sensorineural hearing loss (SNHL) and cognitive impairment by age of 5 per 100,000 mothers screened. The primary factors influencing cost\u2010effectiveness include the effectiveness of VCV in preventing vertical CMV transmission, the prevalence of primary CMV infection during pregnancy, the probability of symptomatic congenital CMV following periconceptional infection, and the cost of serological testing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although the ICER of universal CMV screening appears high in absolute terms, it compares favorably with ICER of commonly offered antenatal screening methods such as first trimester non\u2010invasive prenatal testing for women at intermediate risk of Trisomy 21. Universal screening has the potential for averting childhood morbidity at birth and by 5\u2010years\u2010old. Important variables influencing the ICER include the effectiveness of valacyclovir in preventing vertical transmission, prevalence of primary CMV infection, probability of symptomatic cCMV after periconception primary infection and cost of serology tests.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pd.6848","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T11:33:56Z","timestamp":1751974436000},"page":"1234-1243","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Single\u2010Step Universal First\u2010Trimester Cytomegalovirus Screening and Valacyclovir Prophylaxis in Pregnancy: A Cost\u2010Utility Analysis in a High Seroprevalence Setting"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0985-5455","authenticated-orcid":false,"given":"Zhi Zhen","family":"Lim","sequence":"first","affiliation":[{"name":"Saw Swee Hock School of Public Health National University of Singapore and National University Health System  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clarence","family":"Ong","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health National University of Singapore and National University Health System  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching Yee","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology KK Women's and Children's Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kee Thai","family":"Yeo","sequence":"additional","affiliation":[{"name":"Department of Neonatology KK Women's and Children's Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei Yee","family":"Wan","sequence":"additional","affiliation":[{"name":"Department of Microbiology Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerry Kok Yen","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine KK Women's and Children's Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei Ching","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Maternal\u2010Fetal Medicine KK Women's and Children's Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lay Kok","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Maternal\u2010Fetal Medicine KK Women's and Children's Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Palasanthiran","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Sydney Children's Hospitals Network  Randwick Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Wang","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health National University of Singapore and National University Health System  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9211-0685","authenticated-orcid":false,"given":"Liying","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,8]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra050700"},{"key":"e_1_2_11_3_1","unstructured":"National Center for Immunization and Respiratory Diseases DoVD \u201cCongenital CMV Infection \u201d (2022) https:\/\/www.cdc.gov\/cmv\/clinical\/congenital\u2010cmv.html."},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/rmv.544"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines7040129"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1086\/649903"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy1128"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000477168"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2020.05.038"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471\u20100528.17966"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/rmv.2034"},{"key":"e_1_2_11_12_1","volume-title":"StatPearls","author":"Akpan U. 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