Universal screening for measles immunity during pregnancy: a cost-effectiveness analysis.

BACKGROUND: Measles is a highly contagious illness capable of causing significant morbidity and mortality, including adverse pregnancy outcomes. Routine screening for measles immunity is not currently recommended during pregnancy. Given the increasing frequency of measles outbreaks nationally and globally, awareness of measles immunity status can influence management of pregnant individuals who incur measles exposures, and offer an opportunity for postpartum or preconception vaccination. OBJECTIVES: We sought to evaluate the cost-effectiveness of universal screening for measles immunity during pregnancy in the United States. STUDY DESIGN: A decision-analytic model was constructed to evaluate the cost-effectiveness of universal screening for measles immunity during pregnancy compared to usual care (ie, no screening for measles immunity). The outcome of the decision analysis was quality-adjusted life years (QALYs) of the pregnant person. Model inputs were derived from the literature. Our model ran over two pregnancy cycles with a willingness-to-pay threshold of $100,000 per QALY. Total costs and QALYs were used to measure the incremental cost-effectiveness ratio (ICER) of universal measles screening compared with usual care. Sensitivity analyses were conducted to evaluate the robustness of the results. RESULTS: Universal screening for measles immunity was the dominant strategy. Using a measles exposure rate of 0.1% to reflect the highest risk areas, the ICER of universal screening versus no screening was $166.46/QALY. Tornado sensitivity analyses demonstrated that the cost of measles screening and the probability of measles exposure had greatest impact on the cost-effectiveness of the screening strategy. When varying the measles exposure rate from 0.001-0.1%, screening remained the dominant strategy. During Monte Carlo simulation, measles screening for immunity during pregnancy was cost-saving and increased QALYs in 99.83% of simulations. CONCLUSIONS: Universal screening for measles immunity during pregnancy is a cost-effective strategy. We argue for adoption of universal measles screening during pregnancy in the United States. Until adopted, providers should consider screening their pregnant patients and recommending postpartum vaccination. If implemented, further study will be needed to assess the actual benefit of universal screening.