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Randomized Controlled Trial
. 2021 Nov 2;73(9):e2739-e2745.
doi: 10.1093/cid/ciaa1051.

Cost-effectiveness of Preemptive Therapy Versus Prophylaxis in a Randomized Clinical Trial for the Prevention of Cytomegalovirus Disease in Seronegative Liver Transplant Recipients With Seropositive Donors

Nina Singh  1 , Drew J Winston  2 , Raymund R Razonable  3 , G Marshall Lyon  4 , Fernanda P Silveira  5 , Marilyn M Wagener  1 , Ajit P Limaye  6
Affiliations
Randomized Controlled Trial

Cost-effectiveness of Preemptive Therapy Versus Prophylaxis in a Randomized Clinical Trial for the Prevention of Cytomegalovirus Disease in Seronegative Liver Transplant Recipients With Seropositive Donors

Nina Singh et al. Clin Infect Dis. .

Abstract

Background: The relative costs of preemptive therapy (PET) or prophylaxis for the prevention of cytomegalovirus (CMV) disease in high-risk donor CMV-seropositive/recipient-seronegative (D+/R-) liver transplant recipients have not been assessed in the context of a randomized trial.

Methods: A decision tree model was constructed based on the probability of outcomes in a randomized controlled trial that compared valganciclovir as PET or prophylaxis for 100 days in 205 D+/R- liver transplant recipients. Itemized costs for each site were obtained from a federal cost transparency database. Total costs included costs of implementation of the strategy and CMV disease treatment-related costs. Net cost per patient was estimated from the decision tree for each strategy.

Results: PET was associated with a 10% lower absolute rate of CMV disease (9% vs 19%). The cost of treating a case of CMV disease in our patients was $88 190. Considering cost of implementation of strategy and treatment-related cost for CMV disease, the net cost-savings per patient associated with PET was $8707 compared to prophylaxis. PET remained cost-effective across a range of assumptions (varying costs of monitoring and treatment, and rates of disease).

Conclusions: PET is the dominant CMV prevention strategy in that it was associated with lower rates of CMV disease and lower overall costs compared to prophylaxis in D+/R- liver transplant recipients. Costs were driven primarily by more hospitalizations and higher CMV disease-associated costs due to delayed onset postprophylaxis disease in the prophylaxis group.

Keywords: cytomegalovirus; CMV; cost-effectiveness; preemptive therapy; transplant.

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Figures

Figure 1.
Figure 1.
Decision tree for the comparison of costs associated with 2 approaches for the prevention of cytomegalovirus (CMV) disease in high-risk donor CMV-seropositive and recipient CMV-seronegative (D+/R−) liver transplant patients.
See this image and copyright information in PMC

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