Epidemiology and Economic Burden of Diagnosed Congenital Cytomegalovirus Infection in the First 2 Years of Life among Commercially Insured and Medicaid-Insured Individuals in the United States

Abstract

Purpose

Congenital cytomegalovirus (cCMV) is the leading infectious cause of congenital birth defects. Although approximately 20% to 25% of infants born with cCMV develop long-term health complications such as sensorineural hearing loss, developmental issues, and microcephaly, studies on the disease burden of cCMV are limited. In this study, we assessed the epidemiology, economic burden, and disease burden of clinically diagnosed cCMV in the United States using insurance claims data.

Methods

This retrospective study utilized Merative MarketScan Commercial Claims and Encounters and Multi-State Medicaid data from 2010 to 2019. Annual prevalence of clinically diagnosed cCMV at birth was estimated separately for each payer population. To assess economic burden, infants whose first cCMV diagnosis (index date) was within 1 month of birth were included in the cCMV cohort and matched to infants without cCMV infection for whom an index date was selected at random from all medical claims within 1 month of birth. Cohorts were matched 1:1 on demographics, insurance type, birth, and index years. All infants were required to have ≥2 years of continuous enrollment with prescription drug coverage after the index date (study period). Health care resource use and costs in 2021 USD ($) were summarized separately for the first and second years of the study period. Costs for birth admissions were also described.

Findings

The prevalence of clinically diagnosed cCMV at birth peaked in 2018 at 18.43 and 34.37 per 100,000 in the commercial and Medicaid populations, respectively. One hundred eighteen commercially insured (mean age at index date, 0.3 months; 46.6% female) and 351 Medicaid-insured matched pairs (mean age at index date, 0.2 months; 43.6% female) were included in the economic burden analyses. Mean (median) birth admission costs for commercially and Medicaid-insured infants with clinically diagnosed cCMV were $195,630 ($22,896; vs $24,195 [$3105]) and $57,182 ($9807; vs $5732 [$1566]), respectively. Additionally, excess costs due to cCMV in years 1 and 2 were $9427 ($5089) and $15,901 ($1573) for commercially insured, and $11,104 ($1446) and $12,205 ($721) for Medicaid-insured, respectively. Among potential cCMV sequelae, infants in the cCMV cohort experienced higher rates of hearing loss and developmental/motor delays during the first 2 years.

Implications

Diagnosed prevalence of cCMV at birth increased over time from 2010 to 2018. Infants with clinically diagnosed cCMV have costlier birth admissions and substantial disease burden in the first 2 years of life. These results emphasize the need for primary prevention methods, such as vaccination, to decrease the burden of cCMV.