Six-month prophylaxis is cost effective in transplant patients at high risk for cytomegalovirus infection.

Abstract

The risk of late-onset cytomegalovirus (CMV) infection remains a concern in seronegative kidney and/or pancreas transplant recipients of seropositive organs despite the use of antiviral prophylaxis. The optimal duration of prophylaxis is unknown. We studied the cost effectiveness of 6- versus 3-mo prophylaxis with valganciclovir. A total of 222 seronegative recipients of seropositive kidney and/or pancreas transplants received valganciclovir prophylaxis for either 3 or 6 mo during two consecutive time periods. We assessed the incidence of CMV infection and disease 12 mo after completion of prophylaxis and performed cost-effectiveness analyses. The overall incidence of CMV infection and disease was 26.7% and 24.4% in the 3-mo group and 20.9% and 12.1% in the 6-mo group, respectively. Six-month prophylaxis was associated with a statistically significant reduction in risk for CMV disease (HR, 0.35; 95% CI, 0.17 to 0.72), but not infection (HR, 0.65; 95% CI, 0.37 to 1.14). Cost-effectiveness analyses showed that 6-mo prophylaxis combined with a one-time viremia determination at the end of the prophylaxis period incurred an incremental cost of $34,362 and $16,215 per case of infection and disease avoided, respectively, and $8,304 per one quality adjusted life-year gained. Sensitivity analyses supported the cost effectiveness of 6-mo prophylaxis over a wide range of valganciclovir and hospital costs, as well as variation in the incidence of CMV disease. In summary, 6-mo prophylaxis with valganciclovir combined with a one-time determination of viremia is cost effective in reducing CMV infection and disease in seronegative recipients of seropositive kidney and/or pancreas transplants.

• Authors: Fu L Luan, Linda J Stuckey, Jeong M Park, Daniel Kaul, Diane Cibrik, Akinlolu Ojo
• Journal: Journal of the American Society of Nephrology : JASN (J Am Soc Nephrol) Vol. 20 Issue 11 Pg. 2449-58 (Nov 2009) ISSN: 1533-3450 [Electronic] United States
• PMID: 19762495 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Antiviral Agents
• Valganciclovir
• Ganciclovir

Topics

• Aged
• Antiviral Agents (economics, therapeutic use)
• Cost-Benefit Analysis
• Cytomegalovirus Infections (economics, etiology, prevention & control)
• Female
• Ganciclovir (analogs & derivatives, economics, therapeutic use)
• Humans
• Kidney Transplantation (adverse effects)
• Male
• Middle Aged
• Pancreas Transplantation (adverse effects)
• Risk Factors
• Time Factors
• Valganciclovir