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<strong>KCE</strong> reports vol. 6A Prenatale zorg 162 What are the diagnostic tests available for detection of toxoplasmosis infection and how do they compare in terms of specificity, sensitivity and cost-effectiveness? Study Ref Population Intervention Outcomes Results Comments Study type EL Cubitt 4 [474] Sera from 1000 pregnant Serological screening for Comparison of 49/1000 discordant results among all TES 3 et al., women booking for antenatal antibodies to toxoplasmosis DA, LA and EIAs assays and required repeat testing; 9 1992 care at a London hospital with gold standard based on repeat testing results remained undetermined EIAs: 0/773 false positives, 2/218 false negatives LA: 0/218 false negatives, 1/773 false positives DA: 0/218 false negative, 23/773 false positives What are the diagnostic tests available for detection of congenital toxoplasmosis and how do they compare in terms of specificity, sensitivity, positive predictive value and negative predictive value? Study Ref Population Intervention Outcomes Results Comments Study type EL Foulon 84 122 patients Evaluation of Sensitivity Tests of AF Tests of fetal Cong. TES 3 et al., who had different blood Toxoplasm 1999 seroconversio methods of Specificity Mouse Cell PCR PCR PC MI IgM IgA osis is best n for diagnosing inocula culture assay with R predicted toxoplasma congenital Positive predictive - (CC) MI wit by PCR gondii during toxoplasmosis value tion h and MI of pregnancy, prenatally by (MI) CC AF recruited in 6 amniocentesis Negative Sensitivity 58 15 81 91 93 31 47 38 different and predictive value (%) European toxoplasma reference cordocentesis Infants follow up Specificity (%) PPV (%) 98 93 100 100 96 87 88 97 78 97 100 100 95 78 97 83
<strong>KCE</strong> reports vol. 6A Prenatale zorg 163 Study Ref Population Intervention Outcomes Results Comments Study type centers until 1 year of age to confirm or exclude congenital toxoplasmosis NPV (%) 87 76 94 91 88 79 84 83 What are the available interventions for managing women who are infected with toxoplasmosis? Study Ref Population Intervention Outcomes Results Comments Study Peyron et al., 2002 Wallon et al., 1999 Bader et al., 1997 4 [476] 4 [477] 4 [479] 0 RCTs Treatment vs. no treatment of toxoplasmosis in pregnancy to reduce the risk of congenital toxoplasma infection 9 studies identified Treatment (spiramycin alone, pyrimethamine-sulphonamides, or a combination of the two) vs. no treatment of toxoplasmosis in pregnancy to reduce the risk of congenital toxoplasma infection N/A Decision analysis to compare no testing for congenital toxoplasmosis, targeted screening in cases of abnormalities noted on ultrasound and universal serological screening of pregnant women followed by amniocentesis to diagnose fetal infection in Congenital infection and clinical congenital infection Congenital toxoplasmosis infection vs. no infection Pregnancy loss avoided EL No RCTs identified type SR 1a 5 studies showed effectiveness of treatment (p < 0.001): 22% vs. 52% 13% vs. 100% 21% vs. 47% 0% vs. 100% 4% vs. 83% 4 showed treatment was not effective: 5% vs. 17% 0% vs. 10% 10% vs. 10% 24% vs. 21% By medical treatment: universal screening reduced the number of cases of congenital toxoplasmosis at the ÂcostÊ of 18.5 additional pregnancy losses for each case avoided By pregnancy termination: additional 12.1 EL SR 2b ME 3
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KCE reports 1. Effectiviteit en kos
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