Economic evaluation of systemic treatments for cytomegalovirus retinitis in patients with AIDS.
OBJECTIVE
To determine the cost of using systemic therapy to treat newly diagnosed cytomegalovirus (CMV) retinitis in persons with AIDS.


METHODS
Incidence-based simulation model of CMV treatment from a government payer perspective.


METHODS
Swiss healthcare system.


METHODS
Patients with AIDS and newly diagnosed CMV retinitis.


METHODS
Patients were assigned to 1 of 4 treatment regimens for induction and maintenance therapy: (i) intravenous (IV) cidofovir induction and maintenance (cidofovir IV/IV); (ii) IV foscarnet induction and maintenance (foscarnet IV/IV); (iii) IV ganciclovir induction and maintenance (ganciclovir IV/IV); and (iv) IV ganciclovir induction and oral (PO) ganciclovir maintenance (ganciclovir IV/PO). Following a second relapse, patients were assigned to one of the other regimens.


METHODS
Time to first and subsequent progression, duration of maintenance treatment and direct medical expenditures [1998 Swiss francs (SwF)] .


RESULTS
The median time to first progression was longest for cidofovir IV/IV, followed by foscarnet IV/IV, ganciclovir IV/IV and ganciclovir IV/PO. Mean survival was 13 months and mean costs for this period in the base case were lowest in those initially treated with cidofovir (SwF146,742), followed by initial treatment with foscarnet IV/IV (SwF194,809), ganciclovir IV/PO (SwF195,190) and ganciclovir IV/IV (SwF243,964). Costs were most sensitive to changes in efficacy estimates.


CONCLUSIONS
Of the regimens studied, initiation of treatment with systemic cidofovir appears least costly over a 13-month period.
Lee
T A
TA
Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle 98195, USA. toddlee@u.washington.edu
Sullivan
S D
SD
Veenstra
D L
DL
Ramsey
S D
SD
Steger
P J
PJ
Malinverni
R
R
Pleil
A M
AM
Williamson
T
T
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000191:economics*; D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D000077404:Cidofovir; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy / Q000191:economics*; D003596:Cytosine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D017850:Economics, Pharmaceutical; D017245:Foscarnet / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D015774:Ganciclovir / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D018803:Models, Economic; D063065:Organophosphonates; D009943:Organophosphorus Compounds / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D013557:Switzerland; D017211:Treatment Failure
D000998:Antiviral Agents; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D017245:Foscarnet; D003596:Cytosine; D000077404:Cidofovir; D015774:Ganciclovir