Pharmacoeconomic Impact of Different Regimens to Prevent Cytomegalovirus Infection in Renal Transplant Recipients

Abstract

Background: The aim of this study was to determine the cost impact of four different strategies for prevention of cytomegalovirus (CMV) disease after renal transplantation. Methods: Hospitalization data and medical resource utilization data were prospectively collected alongside two randomized trials. In the first trial, the patients were randomized to 3-month prophylaxis with either oral ganciclovir (1 g t.i.d., n = 36) or valacyclovir (2 g q.i.d., n = 35), and to the control group (n = 12) managed by deferred therapy. In the second trial, the patients were randomly assigned to 3-month valacyclovir prophylaxis (n = 34) or preemptive therapy with valganciclovir (900 mg b.i.d. for a minimum of 14 days, n = 36) for significant CMV DNAemia. The cost analysis involved all real costs directly related to CMV during the first year after renal transplantation. Results: The mean CMV-associated costs per patient were EUR 4,581, 2,577, 4,968, and 8,050 in patients in the ganciclovir, valacyclovir, preemptive, and deferred therapy groups, respectively (p < 0.001). Valacyclovir prophylaxis was significantly less expensive than any other regimen. The cost of one episode of CMV disease was EUR 7,510 per patient. Due to excessive incidence of CMV disease, deferred therapy was the most expensive strategy (p < 0.001). Conclusions: Valacyclovir prophylaxis is less expensive strategy compared with any other regimen.

Updated International Consensus Guidelines on the Management of Cytomegalovirus in Solid-Organ Transplantation

“…The efficacy seems to be comparable with oral ganciclovir prophylaxis (158,159). Major advantages of valacyclovir regimens include less bone marrow suppression and lower cost in some settings; (157,159,160) disadvantages include high pill burden and neuropsychiatric side effects mainly in patients with delayed graft function (157,159).…”

Treatment and prevention of cytomegalovirus infection in heart and lung transplantation: an update

“…32,36,37 In a series of studies, Reischig demonstrated that acyclovir prophylaxis is as effective as pre-emptive 36 or prophylaxis 37 with valganciclovir in preventing CMV infection and disease, but with a better safety profile. In addition, acyclovir strategy had a significantly better pharmacoeconomic impact in patient management 37,38 . The drawbacks of acyclovir strategy were an increased rate of biopsy proven rejection when compared to valganciclovir prophylaxis, and a lower long-term graft survival when compared with pre-emptive valganciclovir.…”

Randomized Trial of Valganciclovir Versus Valacyclovir Prophylaxis for Prevention of Cytomegalovirus in Renal Transplantation

“…On the basis of biopsies for cause, the incidence of BPAR was significantly higher in patients randomized to valacyclovir compared with the valganciclovir prophylaxis (18 Table 2). There were only two patients developing BPAR after CMV DNAemia, whereas in 11 patients, BPAR preceded the development of CMV DNAemia; the remaining 15 patients were not diagnosed with CMV DNAemia.…”

“…An alternative for patients with renal transplants is high-dose valacyclovir, and its efficacy has been documented in randomized studies (10,16,17). Some centers could find valacyclovir to be an attractive option for economic reasons or because of less bone marrow suppression (18). In addition, valacyclovir has been associated with a lower incidence of acute rejection episodes in several studies (16,17,19), with the efficacy of valacyclovir comparable with that of oral ganciclovir (19).…”