Cytomegalovirus disease following liver transplantation: an analysis of prophylaxis strategies.
BACKGROUND
Cytomegalovirus (CMV) infection is an important cause of morbidity and mortality following liver transplantation. Though oral ganciclovir may be used as a prophylactic agent, there is some debate as to whether prophylaxis should be given universally or to targeted 'high risk' sub-groups. We, therefore, analysed the cost-effectiveness of both prophylactic strategies.


METHODS
We performed a retrospective cross-sectional study of adult liver transplant (LT) recipients who developed CMV disease in 1997 and estimated the morbidity and costs associated with disease in these patients. These costs were compared with the estimated cost (based on a previous multi-centre study) of using oral ganciclovir prophylaxis in order to assess the potential cost-effectiveness of introducing different prophylactic regimes.


RESULTS
Universal and targeted prophylaxis would both have prevented all the likely mortality (2 deaths) from CMV disease in that year. The net cost of applying a targeted prophylaxis strategy would have been 206,275 pounds, (i.e. 103,137 pounds per death avoided). The cost per life year saved would have been 15,674 pounds.


CONCLUSIONS
We suggest that LT units should identify patients at high risk for the development of CMV disease and adopt a targeted prophylactic strategy.
Singhal
S
S
Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
Khan
O A
OA
Bramble
R A
RA
Mutimer
D J
DJ
D000284:Administration, Oral; D000998:Antiviral Agents / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000517:prevention & control*; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D016031:Liver Transplantation; D011315:Preventive Medicine / Q000191:economics* / Q000379:methods*; D012189:Retrospective Studies
D000998:Antiviral Agents; D015774:Ganciclovir