(702) Cost-effectiveness of universal screening for measles immunity in pregnancy

Friday, January 31, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Anuradha Devabhaktuni, MD, MPH (she/her/hers)

MFM Fellow
UCLA
Los Angeles, CA, United States

Coauthor(s)

Sarah Boudova, MD, PhD (she/her/hers)

Maternal-Fetal Medicine Fellow
Thomas Jefferson University
Philadelphia, Pennsylvania, United States
Elias Kassir, MD (he/him/his)

MFM Fellow
University of Texas Health Science Center at Houston, McGovern Medical School
Houston, Texas, United States
Sohum Shah, MD (he/him/his)

Fellow
University of California, Los Angeles
Los Angeles, CA, United States
NS

Neil Silverman, MD

Professor of Clinical Obstetrics and Gynecology
David Geffen School of Medicine at UCLA, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine
Los Angeles, California, United States
Christina S. Han, MD

MFM
UCLA
Los Angeles, CA, United States

Objective: Routine screening for measles immunity is not currently recommended in pregnancy. However, vaccination rates have declined and there have been over a dozen measles outbreaks in the United States in 2024. We aim to assess the cost-effectiveness of universal screening for measles immunity in pregnancy.

Study Design: We conducted a cost-effectiveness analysis comparing outcomes and costs associated with universal screening for measles immunity in pregnancy compared to no screening. We designed a Markov model that ran over 3 pregnancy cycles. Our outcomes included: measles exposure, measles infection including mild and severe infections, maternal death, fetal death, preterm delivery, vaccination, and vaccine response in addition to cost and quality-adjusted life years (QALYs). Model inputs were derived from the literature, with a willingness-to-pay threshold of $100,000 per QALY. Sensitivity analyses were conducted to evaluate the robustness of the results.

Results: Universal screening for measles immunity was the dominant strategy. Using the current measles rate of 0.1%, the incremental cost effectiveness ratio (ICER) of universal screening versus no screening was $25.07/QALY. Tornado one-way sensitivity analyses demonstrated that the costs of measles screening and cases, maternal death, and MMR vaccination, along with the probability of measles exposure had greatest impact on the cost-effectiveness of the screening strategy. Univariate sensitivity analysis demonstrated that universal screening for measles was cost-saving until the cost of testing for measles immunity passed $3,957, far exceeding the current average cost of screening, $44. When varying the measles exposure rate, screening remained the dominant strategy.

Conclusion:

Universal screening for measles immunity during pregnancy was identified as a cost-effective strategy supporting its implementation. Until adopted, providers should consider screening their pregnant patients and recommending postpartum vaccination to ensure protection from measles in a subsequent pregnancy.