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Vaccines for the 21st Century: A Tool for Decisionmaking
estimated that 10% of the 4,000 congenitally acquired cases of CMV that are symptomatic at birth (400 cases annually) lead to death after a brief hospitalization following birth.
Of those 3,600 infants who live beyond the initial phase described above, the committee estimated that 90%, or 3,240 infants, experience severe sequelae, and 10%, or 360 infants, experience mild sequelae. These sequelae are life-long. The HUI associated with the mild and severe sequelae were estimated to be .89 and .48, respectively. Those experiencing severe sequelae were estimated to have a reduced lifespan to only 20 years. Table A4–1 illustrates the estimated number of cases in each health state, the duration of time that state is experienced, and the health utility index (HUI) associated with each state.
For the purposes of the calculations in this report, the committee estimated that there are 1,200 cases of moderate CMV disease (e.g., pneumonia and gastrointestinal disease) lasting 1 month, and 1,600 cases of severe CMV disease lasting 2 months in organ-transplant recipients each year. The HUI associated with moderate and severe CMV disease was estimated at .91 and .68 (further adjusted to reflect an altered baseline HUI for organ transplant patients compared to the general population). Further, the committee estimated that 10% of organ transplant patients with severe CMV disease die.
COST INCURRED BY DISEASE
Table A4–2 summarizes the health care costs incurred by cytomegalovirus infections. For the purposes of the calculations used in the report, it was assumed that costs for neurologic sequelae of CMV infection in newborns (whether symptomatic at birth or not) includes regular visits to a specialist for the lifetime of all infected individuals, and special schooling expenses. A small percentage of more severely affected newborns incur costs for hospitalization and long-term care. For infants who are symptomatic at birth, costs for hospitalization, diagnostics, and specialists are included in the calculations. Outpatient follow-up for these patients include several physician visits. For those infants who experience severe sequelae of the CMV infection, costs for 20 years of long-term care are included.
The other group of patients with CMV infections assessed in this report are organ transplant recipients. Patients who develop CMV infections incur costs associated with hospitalization, diagnostics, and multiple physician visits.