title: Which renal transplant patients should receive cytomegalovirus immune globulin? A cost-effectiveness analysis.
abstract: Our study objective was to determine the cost-effectiveness of prophylaxis with cytomegalovirus immune globulin for preventing CMV-associated disease in renal transplant patients. We used a decision analytic model applied to 5 groups of renal transplant recipients at varying risks of developing CMV-associated disease. We obtained the rates of developing CMV-associated disease, graft rejection, and mortality, and the effectiveness of CMV-IG from the published literature. We used actual variable costs of CMV-IG, hospitalization, dialysis, and outpatient follow-up. The incremental cost of administering CMV-IG compared with withholding it ranged from $29,800 per life saved for the highest risk group, CMV-seronegative recipients of kidneys from CMV-seropositive cadaveric donors, to $1.68 million per additional life saved for the lowest risk group, CMV-seronegative recipients of grafts from CMV-seronegative donors. The outcome was somewhat sensitive to the effectiveness of CMV-IG in preventing CMV-associated disease but not sensitive to wide variations in CMV-IG costs, dialysis costs, outpatient costs, and the probability of graft rejection. Our conclusion is that prophylaxis with CMV-IG is very worthwhile for renal transplant recipients at high risk of CMV-associated disease and is possibly worthwhile for some patients at lower risk. The cost-effectiveness of other strategies for preventing CMV-associated disease, such as prophylaxis with acyclovir, CMV vaccine, or unselected immune globulin, should be compared with CMV-IG.
authors.affiliation: Department of Epidemiology, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111.
authors.forename: J
authors.initials: J
authors.lastname: Tsevat
authors.forename: D R
authors.initials: DR
authors.lastname: Snydman
authors.forename: S G
authors.initials: SG
authors.lastname: Pauker
authors.forename: I
authors.initials: I
authors.lastname: Durand-Zaleski
authors.forename: B G
authors.initials: BG
authors.lastname: Werner
authors.forename: A S
authors.initials: AS
authors.lastname: Levey
mesh_terms: D003362:Cost-Benefit Analysis; D003586:Cytomegalovirus Infections / Q000191:economics / Q000517:prevention & control*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007106:Immune Sera / Q000008:administration & dosage*; D007116:Immunization, Passive / Q000191:economics*; D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous; D016030:Kidney Transplantation / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D011292:Premedication / Q000191:economics; D012307:Risk Factors
chemical_list: D007106:Immune Sera; D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous; C045781:cytomegalovirus-specific hyperimmune globulin