Valaciclovir prophylaxis of cytomegalovirus infection and disease in renal transplantation: an economic evaluation.
BACKGROUND
Cytomegalovirus (CMV) disease is a major cause of morbidity and mortality in solid organ transplant patients and is associated with large additional healthcare expenditures. An economic evaluation of valaciclovir CMV prophylaxis in a renal transplant population is reported.


METHODS
Medical resource use data were collected alongside a multicenter multinational randomized, placebo-controlled, double-blind trial of valaciclovir CMV prophylaxis in renal transplantation. Patients were stratified into donor seropositive/recipient sero-negative (D+R-) and recipient seropositive (R+) groups. Patients were followed-up 6 months posttransplant. A cost-effectiveness analysis from the perspective of the French health care system was performed using the number of cases of CMV disease avoided at 6 months as the clinical endpoint.


RESULTS
Resource use was significantly increased among patients who developed CMV disease compared to those who did not develop disease. In the high risk D+R- group, valaciclovir prophylaxis was associated with an average of 5.5 fewer inpatient hospital days (P < OR =0.05) and with significantly lower use of other healthcare resources. In the R+ group, valaciclovir prophylaxis prevented cases of CMV disease at a marginally greater mean cost per patient compared with placebo. For D+R- patients valaciclovir prophylaxis was therefore an economically superior strategy, resulting in fewer cases of CMV disease and lower total mean healthcare expenditures.


CONCLUSIONS
Valaciclovir CMV prophylaxis in renal transplantation is a more cost-effective therapy compared with placebo, in the high-risk D+R- patient population. For the R+ group, the incremental cost per case of CMV disease was modest.
Legendre
C M
CM
Service de Transplantation Rénale, Hospital Saint Louis, Paris, France.
Norman
D J
DJ
Keating
M R
MR
Maclaine
G D
GD
Grant
D M
DM
D000212:Acyclovir / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003586:Cytomegalovirus Infections / Q000517:prevention & control*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use*
D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir