The economic impact of cytomegalovirus infection after liver transplantation.
BACKGROUND
We studied the economic impact of cytomegalovirus (CMV) disease and its effective reduction with antiviral prophylaxis in liver transplant recipients.


METHODS
Analysis of institutional charge data accumulated during a prospective, randomized, controlled trial comparing oral acyclovir 800 mg four times daily for 120 days (ACV) and intravenous ganciclovir 5 mg/kg every 12 h for 14 days followed by ACV for 106 days (GCV) was performed.


RESULTS
Liver transplant recipients who developed CMV disease had significantly higher charges (median: $148,300) than those who developed asymptomatic CMV infection ($119,600) or experienced no CMV infection ($114,100) (P<0.01). A multiple linear regression analysis indicated that CMV disease is associated with a 49% increase in charges, independent of other factors influencing increased hospitalization charges. In CMV-seronegative patients who received a CMV-seropositive donor organ, GCV prophylaxis was associated with a significant reduction in charges, as compared to ACV prophylaxis ($113,900 vs. $153,300, respectively; P=0.02).


CONCLUSIONS
CMV disease is an independent risk factor for increased resource utilization associated with liver transplantation. The use of an effective prophylactic antiviral regimen provides savings in health care resources, particularly in patients at high risk for developing CMV disease.
Kim
W R
WR
Department of Health Science Research, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Badley
A D
AD
Wiesner
R H
RH
Porayko
M K
MK
Seaberg
E C
EC
Keating
M R
MR
Evans
R W
RW
Dickson
E R
ER
Krom
R A
RA
Paya
C V
CV
D000284:Administration, Oral; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000191:economics*; D003365:Costs and Cost Analysis; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000191:economics* / Q000209:etiology / Q000517:prevention & control*; D015774:Ganciclovir / Q000008:administration & dosage* / Q000191:economics*; D006801:Humans; D007275:Injections, Intravenous; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis
D000998:Antiviral Agents; D015774:Ganciclovir