The Cost-Effectiveness of Prophylaxis with Valaciclovir in the Management of Cytomegalovirus after Renal Transplantation

• Published in: The European journal of health economics Vol. 6; no. 2; pp. 172 - 182
• Main Authors: Legendre, Christophe, Beard, Stephen M., Crochard, Anne, Lebranchu, Yvon, Pouteil-Noble, Claire, Richter, Anke, Durand-Zaleski, Isabelle
• Format: Journal Article
• Language: English
• Published: Germany Springer-Verlag 01-06-2005; Springer Nature B.V
• Subjects: Acyclovir - analogs & derivatives; Acyclovir - economics; Acyclovir - therapeutic use; Antiviral Agents - economics; Antiviral Agents - therapeutic use; Clinical medicine; Comparative studies; Cost-Benefit Analysis; Cytomegalovirus; Cytomegalovirus - drug effects; Cytomegalovirus Infections - drug therapy; Cytomegalovirus Infections - prevention & control; Deferred costs; Disease models; Disease prevention; Disease risk; Economic costs; Health economics; Humans; Immunocompromised Host - immunology; Infections; Kidney Transplantation; Kidney transplants; Maintenance costs; Monitoring costs; Original Papers; Prevention; Preventive medicine; Prophylaxis; Valine - analogs & derivatives; Valine - economics; Valine - therapeutic use
• ISSN: 1618-7598; 1618-7601
• DOI: 10.1007/s10198-004-0275-9

Prophylaxis-based antiviral treatment and intensive monitoring followed by pre-emptive antiviral treatment are both commonly used management strategies to reduce risk of cytomegalovirus (CMV) infection following renal transplantation. This study employed a decision-model approach using published efficacy data and information from a recent survey of French clinical practice to consider the relative costs and outcomes associated with CMV prevention strategies for high-risk patient groups. The cost per case of treating tissue invasive and symptomatic CMV disease was estimated at €15,431 and €10,852, respectively. In the highest infection-risk patient group (positive donor with no previous CMV history) prophylactic oral valaciclovir was shown to avoid the greatest number of CMV disease cases (35 cases per 100 transplanted patients) and reduced the overall CMV-related costs per transplanted patient by around 14% over a 'wait-and-treat' baseline strategy. In contrast, intensive monitoring and pre-emptive treatment resulted in a much higher cost per transplanted patient. This analysis suggests that prophylactic treatment remains the most cost-effective approach to the management of CMV in renal-transplanted patients. Further comparative studies between prophylactic and pre-emptive treatment would be a valuable addition to the current evidence based on CMV prevention.