Cost-effectiveness of cytomegalovirus (CMV) disease prevention in patients with AIDS: oral ganciclovir and CMV polymerase chain reaction testing.
OBJECTIVE
To perform a cost-effectiveness analysis of strategies to prevent cytomegalovirus (CMV) disease.


METHODS
Markov model and published data.


METHODS
Hypothetical HIV-infected patients with CD4 cell counts < or = 50 x 10(6)/l and positive CMV serologies.


METHODS
Oral ganciclovir daily versus plasma CMV DNA polymerase chain reaction (PCR) testing every 3 months with oral ganciclovir for patients with positive tests.


METHODS
The number of CMV disease cases prevented by the interventions, life expectancy, disease-free life expectancy, and the cost to extend life by 1 year.


RESULTS
Oral ganciclovir preventive therapy reduces the lifetime number of CMV disease cases by 50 per 1000 cohort, extends life expectancy by 5 days and disease-free life expectancy by 18 days, and costs US$ 1,762,517 per year of life extended. Periodic PCR testing reduces the lifetime number of CMV disease cases by eight per 1000 cohort, extends life expectancy by 1 day and disease-free life expectancy by 3 days, and costs US$ 495,158 per year of life extended. The prevention strategies could be acceptably cost effective only under a combination of optimistic assumptions and reduced costs.


CONCLUSIONS
Oral ganciclovir preventive therapy and periodic plasma testing for CMV PCR with oral ganciclovir for those with positive tests result in small benefits at great cost. They are not cost-effective prevention strategies for persons with advanced HIV infection and positive CMV serologies.
Rose
D N
DN
Department of Community Medicine, AIDS Center, Mount Sinai School of Medicine, New York, New York 10029, USA.
Sacks
H S
HS
D017088:AIDS-Related Opportunistic Infections / Q000191:economics / Q000517:prevention & control* / Q000821:virology; D000284:Administration, Oral; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003586:Cytomegalovirus Infections / Q000150:complications / Q000191:economics / Q000517:prevention & control* / Q000821:virology; D015774:Ganciclovir / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D016133:Polymerase Chain Reaction / Q000191:economics; D016019:Survival Analysis
D000998:Antiviral Agents; D015774:Ganciclovir