Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 May 8:12:1127-1138.
doi: 10.2147/IDR.S196282. eCollection 2019.

Cost-effectiveness analysis of the use of letermovir for the prophylaxis of cytomegalovirus in adult cytomegalovirus seropositive recipients undergoing allogenic hematopoietic stem cell transplantation in Italy

Umberto Restelli  1   2 , Davide Croce  1   2 , Valeria Pacelli  1 , Fabio Ciceri  3   4 , Corrado Girmenia  5
Affiliations

Cost-effectiveness analysis of the use of letermovir for the prophylaxis of cytomegalovirus in adult cytomegalovirus seropositive recipients undergoing allogenic hematopoietic stem cell transplantation in Italy

Umberto Restelli et al. Infect Drug Resist. .

Abstract

Background: The aim of the analysis is to assess the efficiency of the allocation of economic resources related to the use of letermovir cytomegalovirus (CMV) prophylaxis in adult seropositive recipients (R+) patients receiving an allogenic hematopoietic stem cell transplantation (HSCT), compared with a no-prophylaxis strategy, assuming preemptive antiviral administration in both groups from the perspective of the Italian National Health Service (NHS), through a cost-effectiveness analysis. Methods: The model used is based on a decision tree which simulates on a lifetime horizon the progression of CMV infection, considering two alternatives: the use of letermovir CMV prophylaxis, followed by preemptive therapy in case of clinically significant CMV infection, or the avoided use of letermovir CMV prophylaxis, considering direct medical costs (referred to 2018) and quality-adjusted life years (QALYs), both discounted considering a 3% annual rate. Two scenarios were considered, representing the differences related to regional contexts and clinical practice of different typologies of hospitals (public or private accredited with Regional Health Services). Results: The use of letermovir prophylaxis compared with no prophylaxis strategy would lead to an increase of QALYs and direct medical costs in the two scenarios considered, with a mean increase of 0.45 QALYs, and an increase of direct medical costs of 10,222.4 € and of 10,809.9 € in the two scenarios. The incremental cost-effectiveness ratios are equal to 22,564 €/QALY and 23,861 €/QALY. The probabilistic sensitivity analysis conducted showed a percentage of results below the threshold of 40,000 €/QALY of 67.4% and 71.3%; and below a threshold of 25,000 €/QALY equal to 50.4% and to 53.0%. Conclusions: The use of letermovir CMV prophylaxis in adult R+ patients receiving allogenic HSCT, compared with a no-prophylaxis strategy, would be cost-effective for the Italian NHS considering the incremental cost-effectiveness thresholds of 40,000 €/QALY and of 25,000 €/QALY.

Keywords: allogenic hematopoietic stem cell transplantation; cost-effectiveness analysis; cytomegalovirus; letermovir.

PubMed Disclaimer

Conflict of interest statement

DC declares advisory board fees from Mundipharma, Takeda and Abbvie. CG has received honoraria from Gilead Sciences, Astellas Pharma, Basilea, MSD, Pfizer Pharmaceuticals, and Celgene. UR report grants from MSD, during the conduct of the study; personal fees from Astrazeneca, personal fees from Bayer, personal fees from Italfarmaco, outside the submitted work. The remaining authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Structure of the decision tree. Abbreviation: CMV, cytomegalovirus.
Figure 2
Figure 2
Probabilistic sensitivity analysis results – Scenario 1.
Figure 3
Figure 3
Probabilistic sensitivity analysis results – Scenario 2.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Rowe RG, Guo D, Lee M, Margossian S, London WB, Lehmann L. Cytomegalovirus infection in pediatric hematopoietic stem cell transplantation: risk factors for primary infection and cases of recurrent and late infection at a single center. Biol Blood Marrow Transplant. 2016;22(7):1275–1283. doi:10.1016/j.bbmt.2016.04.004 - DOI - PMC - PubMed
    1. George B, Pati N, Gilroy N, et al. Pre-transplant cytomegalovirus (CMV) serostatus remains the most important determinant of CMV reactivation after allogeneic hematopoietic stem cell transplantation in the era of surveillance and preemptive therapy. Transpl Infect Dis. 2010;12(4):322–329. doi:10.1111/j.1399-3062.2010.00504.x - DOI - PubMed
    1. Miller W, Flynn P, McCullough J, et al. Cytomegalovirus infection after bone marrow transplantation: an association with acute graft-v-host disease. Blood. 1986;67(4):1162–1167. - PubMed
    1. Ljungman P, Perez-Bercoff L, Jonsson J, et al. Risk factors for the development of cytomegalovirus disease after allogeneic stem cell transplantation. Haematologica. 2006;91(1):78–83. - PubMed
    1. Italian Bone Marrow Transplantation Group. Libro GITMO 2017–2018. Available from: http://www.gitmo.it/index.php/libri-gitmo-pub. Accessed September, 2018.