Key Message

What Is the Issue?

• Congenital cytomegalovirus (cCMV) is estimated to affect between 0.2% and 2.4% of newborns worldwide, and may cause long-term effects, including hearing loss and neurodevelopmental disability.
• Newborn screening for cCMV can identify affected neonates and provide an opportunity for early treatment, which may reduce any long-term effects from infection.
• We wanted to know if universal newborn screening is a clinically effective and cost-effective intervention for identifying and managing cCMV.

What Did We Do?

• We identified and summarized published literature comparing the clinical effectiveness and cost-effectiveness of universal newborn screening with either targeted newborn screening or no screening for congenital cytomegalovirus in neonates. We also identified and summarized published, evidence-based guidelines that make recommendations concerning the use of newborn screening for congenital cytomegalovirus to help inform decisions considering the use of this intervention.
• An information specialist searched for peer-reviewed and grey literature sources published between January 1, 2014, and March 19, 2024. The search was limited to English-language documents. One reviewer screened articles for eligibility based on predefined criteria, critically appraised the included studies, and narratively summarized the findings.

What Did We Find?

• Evidence from 1 prospective cohort study in the US found that, compared to universal newborn screening for cCMV, targeted newborn screening failed to identify a significant proportion of neonates who developed hearing loss associated with infection.
• Three cost-effectiveness evaluations concluded that universal newborn screening for cCMV was cost-effective when compared to targeted newborn screening or no screening. None of these analyses were specific to the Canadian context.
• While 1 of 3 evidence-based guidelines identified by this review makes a recommendation favouring universal newborn screening for cCMV, 2 evidence-based guidelines recommend against the implementation of universal newborn screening for cCMV (including 1 from the Canadian context), generally citing a lack of sufficient clinical evidence.

What Does This Mean?

• The included cost-effectiveness studies and evidence-based guidelines in this report emphasize that limited clinical evidence is currently available to inform decision-making concerning newborn screening for cCMV.

Jurisdictions where universal newborn screening for cCMV has been implemented provide an opportunity for clinical research to support and inform future decision-making.

The current limitation of available clinical data describing newborn screening for cCMV will require decision-makers to draw from a broader set of inputs and sources than those available from empirical studies.

Key Message

​The private, for-profit imaging landscape is expanding and is anticipated to continue expanding due to changes in some provincial government policies aimed at reducing wait lists.

The collection of data on private imaging can help to build a complete and comprehensive picture of overall procedural capacity across the country.

Estimates on the number of publicly funded exams conducted in private facilities can inform the extent to which wait times have been impacted by the shift in some provincial government policies.

The number of MRI and CT exams conducted at private facilities has increased over the past 4 fiscal years, with the exception of the first year of the COVID-19 pandemic (2020 to 2021).

Payment through private insurance and out-of-pocket payments were the main funding sources for MRI scans in 2021 to 2023 in the private setting. Provincial health care insurance was the main funding source for CT scans conducted at private facilities.

Key Message

What Is the Issue?

It is estimated that 23% of adults in Canada have hypertension. About 1/3 of this population have uncontrolled hypertension, a condition in which (BP) blood pressure levels continue to remain high despite treatment. People with high BP despite being prescribed 3 or more blood pressure-lowering (antihypertensive) medicines are considered to have uncontrolled resistant hypertension. Renal denervation is a therapy that involves disrupting activity in the sympathetic nerves in the renal artery using a minimally invasive catheter-based procedure to treat high BP. We wanted to know if renal denervation would effectively and safely reduce BP in people with uncontrolled hypertension.

What Did We Do? 

We identified and summarized the literature comparing the clinical effectiveness and safety of renal denervation in individuals with uncontrolled hypertension to help guide decisions on the use of this intervention. An information specialist searched for peer-reviewed and grey literature sources published between January 1, 2019, and February 5, 2024. The search was limited to English-language documents. One reviewer screened articles for inclusion based on predefined criteria, critically appraised the included studies, and narratively summarized the findings.

What Did We Find? 

The evidence for this report was based on 2 systematic reviews and 3 randomized controlled trials (RCTs). Renal denervation could lead to a reduction in BP compared to sham in adults with uncontrolled nonresistant hypertension. It is uncertain if renal denervation is an effective treatment for resistant hypertension and suspected hypertensive heart disease due to the methodological limitations of the included studies. Serious side effects of renal denervation were rare.

What Does This Mean? 

Our findings agree with evidence-based guidelines and real-world evidence that suggest renal denervation can be considered a treatment option for patients with uncontrolled nonresistant hypertension. Other factors, including costs and resources, equity, acceptability, and patient selection, should be considered when implementing renal denervation in Canada, where it remains an emerging medical technology. Future research should assess important patient outcomes, such as quality of life.