Aciclovir or ganciclovir universal prophylaxis of cytomegalovirus infection in liver transplantation: an economic analysis.
BACKGROUND
Cytomegalovirus (CMV) following orthotopic liver transplantation can result in significant morbidity and mortality. Prophylaxis with oral aciclovir (ACV) or ganciclovir (GCV) for all transplant recipients (universal prophylaxis) may be beneficial, but which agent is more cost-effective is unknown.


METHODS
A single centre, retrospective study of all patients who had OLT at the Western Australian Liver Transplantation Service was performed. Patients received ACV from 1992 to 1998, and GCV from 1999 to 2001. A comparative cost-effectiveness analysis for the two groups was performed based on the mean total cost of the number of cases of CMV infection and disease as the clinical end-point.


RESULTS
The ACV group comprised of 55 patients and there were 24 in the GCV group. The incidence of CMV disease was 7% and 4% for the ACV and GCV groups, respectively (P > 0.05). For CMV infection it was 16% and 8%, respectively (P > 0.05). GCV prevented more cases of CMV infection and disease than ACV but at an incremental cost of dollars A20,000 (dollars US10,172) per case prevented. Overall, ACV was more cost-effective than GCV by dollars A2200 (dollars US1119) per person. The cost benefit of ACV was derived principally through a reduced pharmaceutical cost. Both agents were well tolerated without development of antiviral resistance.


CONCLUSIONS
Universal prophylaxis of CMV infection-following liver transplantation with aciclovir is more cost-effective than with ganciclovir.
Western Australian Liver Transplantation Service, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. rupertleong@unsw.edu.au
R W L
RW
Leong
D W
DW
Smith
G
G
Garas
J M
JM
Beaman
A W
AW
Mitchell
D I
DI
Heath
A K
AK
House
G P
GP
Jeffrey
D000212:Acyclovir / Q000008:administration & dosage* / Q000191:economics*; D000328:Adult; D017677:Age Distribution; D000998:Antiviral Agents / Q000008:administration & dosage; D001315:Australia; D003362:Cost-Benefit Analysis; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D016527:Drug Costs; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage* / Q000191:economics*; D006084:Graft Rejection / Q000517:prevention & control; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011322:Primary Prevention / Q000191:economics / Q000379:methods; D011336:Probability; D012189:Retrospective Studies; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000998:Antiviral Agents; D015774:Ganciclovir; D000212:Acyclovir