title: Cost advantages of oral drug therapy for managing cytomegalovirus disease.
abstract: Cost advantages of the oral route of drug therapy administration over the intravenous route for managing cytomegalovirus (CMV) disease are described. The overall costs usually are lower for the oral route of administration than for the intravenous route, although the cost to the patient depends on insurance coverage. Other advantages of the oral route include greater safety and convenience, which may improve patient adherence and quality of life. In patients with acquired immunodeficiency syndrome (AIDS), the use of oral ganciclovir instead of intravenous ganciclovir to treat the maintenance phase of CMV retinitis reduced the incidence of neutropenia and sepsis, outpatient and inpatient resource use, and costs. Oral therapy also improved patient quality of life. A cost-effectiveness model for liver transplant recipients found that CMV prophylaxis is warranted for all patients, ganciclovir is preferred over CMV immune globulin i.v. and oral acyclovir for prophylaxis, and the oral route of administration is more cost-effective than the intravenous route for ganciclovir. Valganciclovir, the oral prodrug of ganciclovir, was not included in this model. Oral maintenance therapy is usually cost-effective, safer, and more convenient than intravenous therapy in the management of CMV.
authors.affiliation: University of Utah Health Sciences Center, Department of Pharmacy Services, Salt Lake City, UT, USA. troy.somerville@hsc.utah.edu
authors.forename: K Troy
authors.initials: KT
authors.lastname: Somerville
mesh_terms: D000284:Administration, Oral; D019072:Antibiotic Prophylaxis; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D003586:Cytomegalovirus Infections / Q000150:complications / Q000517:prevention & control*; D015774:Ganciclovir / Q000008:administration & dosage* / Q000191:economics; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000191:economics; D009894:Opportunistic Infections / Q000150:complications / Q000517:prevention & control / Q000821:virology; D016032:Randomized Controlled Trials as Topic
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir