A decision-analytic economic evaluation of valaciclovir prophylaxis for the prevention of cytomegalovirus infection and disease in renal transplantation.
OBJECTIVE
This analysis evaluates the cost-effectiveness of valaciclovir prophylaxis using clinically and economically important health outcomes including graft failure, life-years, and quality-adjusted life-years (QALYs).


METHODS
A Markov model was developed using a randomized, placebo-controlled trial of valaciclovir prophylaxis, together with a published epidemiological study and national renal transplant registry data. The model's population was stratified into two risk groups by donor/recipient cytomegalovirus (CMV) serostatus at transplantation: donor-positive/recipient-negative (D+R-) and recipient-positive (R+) patients. The model estimated costs and health outcomes over a 30-yr period from the perspective of Australian health care providers.


RESULTS
The total health care cost was $3619 lower for D+R- patients receiving valaciclovir prophylaxis compared with those not receiving prophylaxis. D+R- patients receiving valaciclovir gained an extra 0.33 yr of life and 0.27 QALYs. R+ patients receiving valaciclovir prophylaxis gained an extra 0.07 yr of life and 0.05 QALYs, with an incremental cost of $914. This equates to $17 127 per QALY gained, which is highly cost-effective compared with other drugs and health interventions.


CONCLUSIONS
Valaciclovir for the prophylaxis of CMV disease in renal transplant recipients is a cost-effective intervention, significantly reducing the burden of CMV disease to patients and health care providers.
Tilden
Dominic P
DP
M-TAG, London, UK. dtilden@m-tag.net
Chapman
Jeremy
J
Davey
Peter J
PJ
Solly
Michaela L
ML
Crowley
Steven
S
D000212:Acyclovir / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics*; D000998:Antiviral Agents / Q000008:administration & dosage / Q000191:economics*; D018890:Chemoprevention / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D003586:Cytomegalovirus Infections / Q000191:economics / Q000209:etiology* / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000191:economics; D008390:Markov Chains; D008954:Models, Biological; D018803:Models, Economic; D011788:Quality of Life; D016019:Survival Analysis; D016896:Treatment Outcome; D000077483:Valacyclovir; D014633:Valine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics*
D000998:Antiviral Agents; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir